Korean J Pediatr.  2016 Mar;59(3):145-148. 10.3345/kjp.2016.59.3.145.

Acute tubular necrosis as a part of vancomycin induced drug rash with eosinophilia and systemic symptoms syndrome with coincident postinfectious glomerulonephritis

• Kim KM
• Sung K
• Yang HK
• Kim SH
• Kim HY
• Ban GH
• Park SE
• Lee HD
• Kim SY

• KMID: 2163059
• DOI: http://doi.org/10.3345/kjp.2016.59.3.145

Abstract

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal condition characterized by skin rash, fever, eosinophilia, and multiorgan involvement. Various drugs may be associated with this syndrome including carbamazepine, allopurinol, and sulfasalazine. Renal involvement in DRESS syndrome most commonly presents as acute kidney injury due to interstitial nephritis. An 11-year-old boy was referred to the Children's Hospital of Pusan National University because of persistent fever, rash, abdominal distension, generalized edema, lymphadenopathy, and eosinophilia. He previously received vancomycin and ceftriaxone for 10 days at another hospital. He developed acute kidney injury with nephrotic range proteinuria and hypocomplementemia. A subsequent renal biopsy indicated the presence of acute tubular necrosis (ATN) and late exudative phase of postinfectious glomerulonephritis (PIGN). Systemic symptoms and renal function improved with corticosteroid therapy after the discontinuation of vancomycin. Here, we describe a biopsy-proven case of severe ATN that manifested as a part of vancomycin-induced DRESS syndrome with coincident PIGN. It is important for clinicians to be aware of this syndrome due to its severity and potentially fatal nature.

Keyword

DRESS syndrome; Acute kidney injury; Acute kidney tubular necrosis; Postinfectious glomerulonephritis; Vancomycin

MeSH Terms

Acute Kidney Injury
Allopurinol
Biopsy
Busan
Carbamazepine
Ceftriaxone
Child
Drug Hypersensitivity Syndrome
Edema
Eosinophilia*
Exanthema*
Fever
Glomerulonephritis*
Humans
Kidney Tubular Necrosis, Acute
Lymphatic Diseases
Male
Necrosis*
Nephritis, Interstitial
Proteinuria
Sulfasalazine
Vancomycin*
Allopurinol
Carbamazepine
Ceftriaxone
Sulfasalazine
Vancomycin