Yeungnam Univ J Med.  2016 Jun;33(1):59-63. 10.12701/yujm.2016.33.1.59.

DRESS syndrome with acute interstitial nephritis caused by quinolone and non-steroidal anti-inflammatory drugs

• Kim SJ
• Nam YH
• Juong JY
• Kim EY
• Lee SM
• Son YK
• Nam HJ
• Kim KH
• Lee SK

• KMID: 2328117
• DOI: http://doi.org/10.12701/yujm.2016.33.1.59

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe drug-induced hypersensitivity syndrome characterized by hematological abnormalities and multiorgan involvement. Liver involvement is the most common visceral manifestation. However, renal failure has been rarely described. The common culprit drugs are anticonvulsants and allopurinol. We experienced a patient with DRESS syndrome with acute interstitial nephritis caused by concomitant administration of quinolone and non-steroidal anti-inflammatory drugs (NSAIDs). A 41-year-old man presented with a diffuse erythematous rash and fever which developed after administration of quinolone and NSAIDs for a month due to prostatitis. He was diagnosed with DRESS syndrome. Skin rash, fever, eosinophilia, and elevations of liver enzymes improved with conservative treatment and discontinuation of the causative drugs. However, deterioration of his renal function occurred on day 8 of admission. The levels of blood urea nitrogen and serum creatinine increased and oliguria, proteinuria and urinary eosinophils were observed. Ultrasonography showed diffuse renal enlargement. The clinical features were compatible with acute interstitial nephritis. Despite intravenous rehydration and diuretics, renal function did not improve. After hemodialysis, his renal function recovered completely within 2 weeks without administration of systemic corticosteroid.

Keyword

Drug hypersensitivity; Interstitial nephritis; Quinolone

MeSH Terms

Adult
Allopurinol
Anti-Inflammatory Agents, Non-Steroidal
Anticonvulsants
Blood Urea Nitrogen
Creatinine
Diuretics
Drug Hypersensitivity
Drug Hypersensitivity Syndrome*
Eosinophilia
Eosinophils
Exanthema
Fever
Fluid Therapy
Humans
Hypersensitivity
Liver
Nephritis, Interstitial*
Oliguria
Prostatitis
Proteinuria
Renal Dialysis
Renal Insufficiency
Ultrasonography
Allopurinol
Anti-Inflammatory Agents, Non-Steroidal
Anticonvulsants
Creatinine
Diuretics