A DGReview of :"Ciprofloxacin-induced acute interstitial nephritis and autoimmune hemolytic anemia"

Renal Failure

08/27/2003

By Deanna M Green, PhD

Concomitant acute interstitial nephritis (AIN) and autoimmune haemolytic anaemia is a potential danger associated with ciprofloxacin treatment, according to a recent case study from Singapore and the United States.

Ciprofloxacin is a broad spectrum antibiotic commonly used in daily clinical practice. Adverse events associated with ciprofloxacin are rare and predominantly affect the gastrointestinal tract and central nervous system. Although AIN and intravascular haemolysis have been reported with ciprofloxacin treatment, the combination is extremely rare.

Salim Lim, MD, at the Tan Tock Seng Hospital, Singapore, and Muhammad G. Alam, MD, MPH at the University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States, described a case study in which a patient developed both AIN and haemolytic anaemia after taking ciprofloxacin.

The patient was a 79-year-old man admitted for fever, generalised malaise, and weakness and was treated with intravenous ciprofloxacin for a urinary infection. The patient subsequently developed a rash on his chest, back, and arms and the antibiotic was discontinued. The patient was discharged 1 week later.

Two days after discharge, the patient was admitted to another hospital due to jaundice, nausea, and vomiting and soon became oligoanuric. Haemoglobin levels gradually decreased, and blood urea nitrogen and creatinine levels increased to 171 mg/dL and 9.8 mg/dL, respectively. The patient was treated with 60 mg daily prednisone.

Due to deterioration of renal function and severe anaemia, the patient was transferred to another hospital where he began haemodialysis and was given methylprednisolone (125 mg every 8 h).

The diagnosis of autoimmune haemolytic anaemia and AIN associated with ciprofloxacin was made based on positive results for IgG and complement in the direct antiglobulin (coombs) test and from the observation of extensive diffuse interstitial lymphocytic infiltrates with accompanying interstitial oedema and tubular destructions from kidney biopsy.

Haemoglobin levels remained stable and haemolytic anaemia further improved with steroid therapy. However, the AIN was irreversible. The patient developed end-stage renal disease and remained dependent on dialysis after discharge.

The authors conclude that "this is the first case report on ciprofloxacin-induced AIN and coombs-positive autoimmune haemolytic anaemia."

Ren Fail Jul 2003:25:4:647-51. "Ciprofloxacin-induced acute interstitial nephritis and autoimmune hemolytic anemia"