Allergic Nephropathy Associated With Ciprofloxacin

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We report a case of ciprofloxacin-related allergic tubulointerstitial nephritis, which manifested as nonoliguric renal failure, eosinophilia, and eosinophiluria. Our patient responded to discontinuation of ciprofloxacin therapy and oral administration of a brief course of corticosteroids. Although rare, allergic tubulointerstitial nephritis apparently can be caused by ciprofloxacin therapy. Clinicians should be aware of this entity.

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REPORT OF CASE

A 78-year-old man with extensive open injuries of the face and head was admitted to the trauma center at our institution after a large tractor tire had exploded during accidental overinflation. An emergency surgical procedure was done for repair of sinus fractures, facial fractures, an open-skull fracture, complex facial lacerations, and a hemorrhagic right ocular globe and for decompression and repair of the macerated brain and meninges.

Because of postoperative fever and the probability of

DISCUSSION

We believe that this patient's acute renal failure was due to an allergic tubulointerstitial nephritis. The presence of rapid-onset azotemia, peripheral blood eosinophilia, and eosinophiluria supports this diagnosis.5, 6 The only medications being used by the patient at that time were ciprofloxacin, ranitidine, and phenytoin. Ranitidine has not been reported to cause allergic tubulointerstitial nephritis. The fact that the patient was rechallenged with famotidine, which is structurally similar

CONCLUSION

This case should serve notice to clinicians that ciprofloxacin can rarely cause allergic tubulointerstitial nephritis. This diagnosis should be considered if azotemia is detected during treatment with ciprofloxacin.

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Current address: Oakland Naval Hospital, Oakland, California.

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