Wegener's granulomatosis in a patient with apparent drug-induced acute interstitial nephritis

We describe a patient whose clinical presentation was suggestive of drug-induced acute interstitial nephritis (AIN). A renal biopsy and serologic testing led instead to the diagnosis of Wegener's granulomatosis (WG) with necrotizing crescentic glomerulonephritis. Treatment with corticosteroids...

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Bibliographic Details
Published in:The American journal of the medical sciences 1998-03, Vol.315 (3), p.216-219
Main Authors: HAQQIE, S. S, PHELPS, K. R, SINGH, J, URIZAR, R. E
Format: Article
Language:English
Subjects:
Acute Disease
Aged
Antibodies, Antineutrophil Cytoplasmic - blood
Biological and medical sciences
Biopsy
Cyclophosphamide - therapeutic use
Diagnosis, Differential
Glomerulonephritis - complications
Granulomatosis with Polyangiitis - diagnosis
Granulomatosis with Polyangiitis - drug therapy
Granulomatosis with Polyangiitis - pathology
Humans
Immunosuppressive Agents - therapeutic use
Male
Medical sciences
Methylprednisolone - administration & dosage
Methylprednisolone - therapeutic use
Microscopy, Electron
Nephritis, Interstitial - chemically induced
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
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Summary:We describe a patient whose clinical presentation was suggestive of drug-induced acute interstitial nephritis (AIN). A renal biopsy and serologic testing led instead to the diagnosis of Wegener's granulomatosis (WG) with necrotizing crescentic glomerulonephritis. Treatment with corticosteroids and cyclophosphamide resulted initially in complete recovery of renal function, and an exacerbation of acute renal failure after doses of these agents had been tapered responded to resumption of the original regimen. We report this case to emphasize the potentially identical presentations of AIN and WG. Since the two conditions are treated differently, we suggest that the diagnosis of AIN should be accepted only after biopsy confirmation.
ISSN:0002-9629
1538-2990
DOI:10.1097/00000441-199803000-00014