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Acute interstial nephritis: case report A 56-year-old man with polymicrobial osteomyelitis developed piperacillin/tazobactam-induced acute interstitial nephritis (AIN) with possible meropenem crosssensitivity. The man received piperacillin/tazobactam [dosage and route not stated] for polymicrobial osteomyelitis. After 6 weeks of treatment, he developed acute renal failure accompanied by fever and rash. A renal ultrasound did not show any abnormalities. Urinalysis revealed eosinophilia, hyaline casts, white blood cells and proteinuria. He was treated with empirical corticosteroids and dialysis for AIN. During hospitalisation, he developed a nosocomial infection which was treated with meropenem [dosage and route not stated] on hospital day 15. Following administration of meropenem his renal function worsened and his rash recurred [time to reaction onset not clearly stated]. Drug-induced AIN was suspected with crosssensitivity of meropenem with piperacillin/tazobactam although this was not confirmed by renal biopsy due to his fragile condition. The man’s renal function initially improved over the first 2 weeks postadmission before introduction of meropenem which resulted in deterioration of his symptoms. Meropenem was discontinued. His renal function returned to baseline on day 46 after 6 weeks of corticosteroid therapy. The cross-sensitivity reaction with meropenem may have caused a delayed response to empirical corticosteroid therapy and possible development of pulmonary-renal syndrome during hospitalisation. Author comment: "This case suggests that cross-sensitivity between piperacillin–tazobactam and meropenem can result in drug-induced AIN." Liu TJ, et al. Piperacillin-tazobactam-induced acute interstitial nephritis with possible meropenem cross-sensitivity in a patient with osteomyelitis. American Journal of Health-System Pharmacy 69: 1109, No. 13, Jul 2012. Available from: 803076229 URL: http://dx.doi.org/10.2146/ajhp120068 - USA

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Reactions 1 Sep 2012 No. 1417