Acute tubulointerstitial nephritis with multiple organ involvement including fatal adrenalitis: A case report with autopsy findings

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. © 2012 The Japanese Society of Internal Medicine.