Abstract
A 63-year-old man with pharyngeal cancer had been prescribed pilocarpine hydrochloride for xerostomia after concomitant chemoradiotherapy. After 6 months of taking pilocarpine hydrochloride, he was referred to our hospital due to gradually developing renal insufficiency. The patient underwent detailed urinalysis, blood chemistry analysis, immune-serology testing. A renal biopsy was also performed. He was diagnosed with chronic tubulointerstitial nephritis (TIN) caused by lymphocytic infiltration of the interstitium, tubular atrophy, and interstitial fibrotic changes. Infections, autoimmune diseases, and genetic factors were ruled out as causes of TIN; a drug-induced lymphocyte stimulation test confirmed that he had high stimulation index scores for pilocarpine hydrochloride and a normal range stimulation score for other supplements. These results indicated that the TIN could have been induced by pilocarpine hydrochloride. Drug discontinuation partly improved his renal function and tubule marker levels. To our knowledge, this is the first report of TIN following administration of pilocarpine hydrochloride. This finding could contribute to future treatment decisions for patients with TIN and those using pilocarpine hydrochloride.
Highlights
Pilocarpine hydrochloride, a cholinergic agonist, is used for treating xerostomia associated with radiotherapy for head and neck cancer and for Sjögren’s syndrome [1,2,3]
Is a renal histologic lesion characterized by the presence of inflammatory infiltrates and edema within the tubulointerstitial compartment, which usually does not affect the glomerular and vascular compartments [5]
Immunological tests for C-reactive protein (CRP), myeloperoxidase antineutrophil cytoplasmic antibody (MPOANCA), proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA), antinuclear antibody (ANA), anti-SS-A/Ro antibodies, and anti-SS-B/La antibodies were all negative
Summary
Pilocarpine hydrochloride, a cholinergic agonist, is used for treating xerostomia associated with radiotherapy for head and neck cancer and for Sjögren’s syndrome [1,2,3]. Common side effects include miosis, hyperhidrosis, nausea, liver dysfunction, diarrhea, frequent urination; serious side effects include interstitial pneumonia and loss of consciousness [4]. Nephrotoxicity by pilocarpine hydrochloride has to date, not been reported. Is a renal histologic lesion characterized by the presence of inflammatory infiltrates and edema within the tubulointerstitial compartment, which usually does not affect the glomerular and vascular compartments [5]. Any drug can cause TIN; clinical and laboratory findings, including renal biopsy, are important for diagnosis [6]. A rare instance of pilocarpine hydrochloride-induced TIN
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