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Da Rosa GP, Marques S, Coelho F, Pereira E, Ferreira E, Rodrigues-Pereira P, Dias C, Bettencourt P. Azathioprine-induced interstitial nephritis in an anti-neutrophil cytoplasmic antibody (ANCA) myeloperoxidase (MPO) vasculitis patient. Eur J Rheumatol 2018; 5:135-138. [PMID: 30185363 DOI: 10.5152/eurjrheum.2017.17062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/20/2017] [Indexed: 11/22/2022] Open
Abstract
Azathioprine (AZA) is used in a wide array of autoimmune diseases, still corresponding to the mainstay maintenance therapy in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Although generally well-tolerated, several side effects are recognized. We report the case of a 50-year-old Caucasian man with kidney-limited ANCA myeloperoxidase (MPO) vasculitis who presented with general malaise, fever, worsening renal function, and elevated inflammatory markers 2 weeks after the initiation of therapy with oral AZA. Although a disease relapse was suspected, renal biopsy revealed an eosinophilic infiltrate, suggestive of acute interstitial nephritis. After suspension of AZA, a sustained improvement of renal function and normalization of inflammatory markers was observed. A diagnosis of allergic interstitial nephritis secondary to AZA was established, corresponding to the first biopsy-proven case described in an ANCA MPO vasculitis patient. Although rare, renal toxicity of AZA must be present in the clinician's mind, avoiding the straightforward assumption of disease relapse in the case of worsening renal function.
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Affiliation(s)
- Gilberto Pires Da Rosa
- Department of Internal Medicine, São João Hospital Center, Porto, Portugal.,Autoimmune Diseases Consultation, São João Hospital Center, Porto, Portugal
| | - Sofia Marques
- Department of Nephrology, São João Hospital Center, Porto, Portugal
| | - Fátima Coelho
- Department of Internal Medicine, São João Hospital Center, Porto, Portugal.,Autoimmune Diseases Consultation, São João Hospital Center, Porto, Portugal
| | - Edite Pereira
- Department of Internal Medicine, São João Hospital Center, Porto, Portugal.,Autoimmune Diseases Consultation, São João Hospital Center, Porto, Portugal
| | - Ester Ferreira
- Department of Internal Medicine, São João Hospital Center, Porto, Portugal.,Autoimmune Diseases Consultation, São João Hospital Center, Porto, Portugal
| | | | - Carlos Dias
- Department of Internal Medicine, São João Hospital Center, Porto, Portugal.,Autoimmune Diseases Consultation, São João Hospital Center, Porto, Portugal
| | - Paulo Bettencourt
- Department of Internal Medicine, São João Hospital Center, Porto, Portugal.,Autoimmune Diseases Consultation, São João Hospital Center, Porto, Portugal
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