Acute Tubulointerstitial Nephritis with Multiple Organ Involvement Including Fatal Adrenalitis: A Case Report with Autopsy Findings

Ryo Koda; Ryuji Aoyagi; Etsuo Okazaki; Shigeru Miyazaki; Tetsuro Takeda; Junichiro Kazama; Ichiei Narita

doi:10.2169/internalmedicine.51.8344

CASE REPORTS

Acute Tubulointerstitial Nephritis with Multiple Organ Involvement Including Fatal Adrenalitis: A Case Report with Autopsy Findings

Ryo Koda, Ryuji Aoyagi, Etsuo Okazaki, Shigeru Miyazaki, Tetsuro Takeda, Junichiro Kazama, Ichiei Narita

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Keywords: carbamazepine, tubulointerstitial nephritis, adrenal failure, autopsy

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 20 Pages 2917-2922

DOI https://doi.org/10.2169/internalmedicine.51.8344

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Abstract

A 68-year-old woman with Alzheimer's disease developed renal dysfunction after starting carbamazepine for epilepsy. Although Ga-67 citrate scintigraphy strongly suggested interstitial nephritis, renal biopsy was not possible due to her overall state. At 61 days after admission, she died of unexplained shock. At autopsy, severe infiltration of T lymphocytes was noted, not only in the renal interstitium but also in the liver, lungs, and adrenal glands. Adrenal failure was a possible cause of shock. In carbamazepine-induced interstitial nephritis, multiple organ involvement including fatal adrenalitis should be considered.

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