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Pantoprazole/piperacillin/tazobactam Acute interstitial nephritis: case report

A 29-year-old man developed acute interstitial nephritis (AIN) during treatment with piperacillin/tazobactam and pantoprazole. The man, who presented with painless jaundice secondary to a common bile duct stone, was found to have cholestatic hepatic dysfunction. Additionally, his hospital course was complicated by recurrent fevers and leukocytosis [aetiology not stated], and he started receiving piperacillin/tazobactam 3.375g through extended infusion every 8 hours. He had been receiving pantoprazole as home medication [not all dosages, routes and indication stated]. The man’s therapy with piperacillin/tazobactam was switched to meropenem on day 21 of hospitalization due to suspected AIN [time to reaction onset not stated]. His serum creatinine (SCr) was increased from 1 mg/dL on day 1 to 2.33 mg/dL on day 23 of hospitalisation. Also, his blood urea nitrogen level was 50 mg/dL, and a urine smear was positive for eosinophils. His SCr level started improving following withdrawal of piperacillin/tazobactam; however, worsened again 6 days later. Approximately 1 month later, he was discharged with a SCr 2.51 mg/dL. Three weeks later, he was hospitalised with SCr 2.57 mg/dL. Therapy with piperacillin/tazobactam was restarted on hospital day 8 for acute cystitis. He received piperacillin/tazobactam for 5 days, and his SCr increased to 3.25 mg/dL. Additionally, he developed new fevers (up to 39.1°C), and had documented peripheral eosinophilia. His renal biopsy revealed eosinophils in the medullary interstitium. Piperacillin/tazobactam was again discontinued, and SCr continued to increase (5.24 mg/dL). It was noted that recurrent piperacillin/tazobactam induced AIN following rechallenge of piperacillin/tazobactam, led to permanent renal dysfunction. Thereafter, he remained oliguric and needed renal replacement therapy while hospitalised and following discharge. Naranjo algorithm demonstrated piperacillin/tazobactam induced AIN as a probable adverse drug reaction based on a score of 7. Also, another medication associated with AIN was found to be his home medication pantoprazole. Parsels KA, et al. Recurrent Renal Dysfunction Secondary to Probable Piperacillin-Tazobactam-Induced Acute Interstitial Nephritis. Annals of Pharmacotherapy : no pagination, 25 Jun 2020. Available from: URL: http://doi.org/10.1177/1060028020936778

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Reactions 12 Sep 2020 No. 1821