Abstract
BackgroundCarbamazepine-induced acute kidney injury is mainly caused by acute tubulointerstitial nephritis. Only one case of carbamazepine-induced eosinophilic granulomatosis with polyangiitis (EGPA) with acute kidney injury has been reported. But the patient’s condition improved with the immediate discontinuation of carbamazepine. We present a case requiring hemodialysis and steroid therapy for carbamazepine-induced EGPA with acute kidney injury.Case presentationA 77-year-old man with allergic rhinitis was prescribed carbamazepine for trigeminal neuralgia 1 year ago. He developed rash and itching on the left forearm 1 month ago and was diagnosed with polymorphic exudative erythema and admitted to our hospital. Laboratory data revealed leukocytosis eosinophilia and renal failure (serum creatinine 9.2 mg/dL). Carbamazepine was discontinued, and hemodialysis was initiated because of acute uremia and oliguria. A lymphocyte stimulation test for carbamazepine was positive. Polyneuropathy in the upper and lower extremities was observed by electromyogram, and a renal biopsy indicated EGPA. The main clinical findings were allergic rhinitis, eosinophilia, and vasculitis symptoms, such as multiple mononeuritis and muscle weakness. Renal biopsy showed diffuse cellular infiltration dominated by eosinophils in the interstitium, with granulomatous changes in particular observed around the arteriole. Fibrinoid necrosis was also observed around the arteriole. We therefore made a diagnosis of carbamazepine-induced EGPA. Following steroid therapy after the discontinuation of carbamazepine, the patient was discharged from our hospital without hemodialysis. In contrast with the previous case of EGPA, the present case had the following characteristics: (1) elderly male patient, (2) hemodialysis required for acute kidney injury, and (3) improved renal function following steroid therapy after discontinuation of carbamazepine.ConclusionOur case report indicates that early diagnosis and appropriate therapy can improve acute kidney injury caused by carbamazepine and allow the patient to discontinue dialysis.
Highlights
Carbamazepine-induced acute kidney injury is mainly caused by acute tubulointerstitial nephritis
Our case report indicates that early diagnosis and appropriate therapy can improve acute kidney injury caused by carbamazepine and allow the patient to discontinue dialysis
Eosinophilic granulomatosis with polyangiitis (EGPA), known as Churg-Strauss syndrome, is defined as an eosinophil-rich necrotizing vasculitis of small-tomedium blood vessels according to the 2012 Chapel Hill consensus conference [1]
Summary
We report the development of EGPA in an elderly male patient following the oral administration of carbamazepine for more than 1 year. One case of carbamazepine-induced EGPA has been reported to date [18] This case was a 42-year-old man who developed the condition 2 years after starting oral administration of carbamazepine. When this patient was hospitalized, serum creatinine was 3.0 mg/dL and his renal function was improved by only discontinuation of carbamazepine. Our case highlights two key observations: (1) hemodialysis was required for acute kidney injury, the renal function was improved by the steroid therapy after the discontinuation of carbamazepine, and (2) an elderly man treated with carbamazepine for 2 years (Table 2). Allergies in the elderly frequently involve environmental factors, including drugs [19]
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