Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Acute tubular necrosis as a part of vancomycin induced drug rash with eosinophilia and syste­mic symptoms syndrome with coincident post­infectious glomerulonephritis

  • Kim, Kyung Min (Department of Pediatrics, Pusan National University Children's Hospital) ;
  • Sung, Kyoung (Department of Pediatrics, Pusan National University Children's Hospital) ;
  • Yang, Hea Koung (Department of Pediatrics, Pusan National University Hospital) ;
  • Kim, Seong Heon (Department of Pediatrics, Pusan National University Children's Hospital) ;
  • Kim, Hye Young (Department of Pediatrics, Pusan National University Hospital) ;
  • Ban, Gil Ho (Department of Pediatrics, Pusan National University Children's Hospital) ;
  • Park, Su Eun (Department of Pediatrics, Pusan National University Children's Hospital) ;
  • Lee, Hyoung Doo (Department of Pediatrics, Pusan National University Children's Hospital) ;
  • Kim, Su Young (Department of Pediatrics, Pusan National University Children's Hospital)
  • Received : 2014.04.10
  • Accepted : 2014.07.08
  • Published : 2016.03.15
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Abstract

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal condition characterized by skin rash, fever, eosinophilia, and multiorgan involvement. Various drugs may be associated with this syndrome including carbamazepine, allopurinol, and sulfasalazine. Renal involvement in DRESS syndrome most commonly presents as acute kidney injury due to interstitial nephritis. An 11-year-old boy was referred to the Children's Hospital of Pusan National University because of persistent fever, rash, abdominal distension, generalized edema, lymphadenopathy, and eosinophilia. He previously received vancomycin and ceftriaxone for 10 days at another hospital. He developed acute kidney injury with nephrotic range proteinuria and hypocomplementemia. A subsequent renal biopsy indicated the presence of acute tubular necrosis (ATN) and late exudative phase of postinfectious glomerulonephritis (PIGN). Systemic symptoms and renal function improved with corticosteroid therapy after the discontinuation of vancomycin. Here, we describe a biopsy-proven case of severe ATN that manifested as a part of vancomycin-induced DRESS syndrome with coincident PIGN. It is important for clinicians to be aware of this syndrome due to its severity and potentially fatal nature.

Keywords

References

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