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NDT Advance Access originally published online on June 9, 2009
Nephrology Dialysis Transplantation 2009 24(9):2940-2942; doi:10.1093/ndt/gfp277
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


A case of sulphasalazine-induced DRESS syndrome with delayed acute interstitial nephritis

Jean-François Augusto1,2,3, Johnny Sayegh1, Amélie Simon1, Anne Croue4, Jean-Marie Chennebault5, Maud Cousin1,3 and Jean-François Subra1,3

1 Service de Néphrologie-Dialyse-Transplantation 2 Service de Réanimation Médicale et Médecine Hyperbare, CHU Angers, F-49933 3 UPRES EA 3863, University of Angers, F-49035 4 Département de Pathologie Cellulaire et Tissulaire 5 Département de Maladie Infectieuses et Tropicales, CHU Angers, F-49933, Angers, France

Correspondence and offprint requests to: Jean-François Augusto; E-mail: jfaugusto{at}chu-angers.fr



  Abstract

Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a rare and severe drug-induced hypersensitivity syndrome characterized by haematological abnormalities (hypereosinophilia and/or mononucleosis) and multiorgan involvement. Renal failure has been rarely described. We report the case of a 77-year-old female with sulphasalazine-induced DRESS syndrome who improved rapidly on corticosteroid treatment. After prednisone withdrawal, the patient developed renal failure that necessitated a session of haemodialysis. A kidney biopsy showed acute tubulointerstitial nephritis with an intense lymphocytic infiltrate and tubular necrosis. Kidney function normalized after a further 2 weeks of corticosteroid treatment. This is the first histologically proven case of acute tubulointerstitial nephritis in the setting of sulphasalazine-induced DRESS syndrome.

Keywords: acute tubulointerstitial nephritis; DRESS syndrome; HHV-6; sulphasalazine

Received for publication: 22. 3.09
Accepted in revised form: 19. 5.09


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