医学
急性肾损伤
坏死性血管炎
血管炎
环磷酰胺
嗜酸性粒细胞增多症
别嘌呤醇
肾
血液透析
病理
皮肤病科
内科学
化疗
疾病
作者
Anthony J. Esposito,Ryan Murphy,Mirna N. Toukatly,Osama W. Amro,Bryan Kestenbaum,Behzad Najafian
出处
期刊:Clinical Nephrology
[Dustri-Verlag Dr. Karl Feistle]
日期:2017-06-01
卷期号:87 (06): 316-319
被引量:17
摘要
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal adverse drug reaction with variable renal involvement. We report the case of a man who presented with allopurinol-induced DRESS and acute kidney injury (AKI) requiring hemodialysis. Kidney biopsy revealed eosinophilic tubulointerstitial nephritis and necrotizing vasculitis of the intralobular arteries without systemic markers of vasculitis. After cyclophosphamide and glucocorticoids, his symptoms and AKI resolved. To our knowledge, this is the first case of kidney-limited necrotizing vasculitis, questioning whether a biopsy should be routinely performed in patients with DRESS accompanied by severe AKI. It is possible that kidney-limited necrotizing vasculitis is an under-diagnosed manifestation of DRESS syndrome, and in such a setting, early recognition, stopping the offending agent, and use of aggressive immunosuppressive therapy, including cyclophosphamide, may lead to a favorable outcome. .
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