A non-immunocompromised host with nontuberculous mycobacteria-associated tubulointerstitial nephritis

Soken Hattori, Kiichiro Fujisaki, Yusuke Nakamata, Takuro Kometani, Takafumi Nakashima, Kazuki Koga, Sho Sasaki, Ryosuke Yamate, Takashi Matono, akihiro tsuchimoto, Toshiaki Nakano

Research output: Contribution to journalArticlepeer-review

Abstract

A 50-year-old man was admitted to our hospital with the complaints of fever and general malaise. He had no history of human immunodeficiency virus (HIV) infection or treatment with immunosuppressive agents. We performed renal biopsy to investigate possible acute kidney injury. Pathological findings showed inflammatory cell infiltration, including granulomatous lesions in the interstitium. We diagnosed the patient with acute granulomatous tubulointerstitial nephritis. We initiated prednisolone (PSL) 40 mg/day (0.6 mg/kg), in combination with isoniazid for a latent tuberculosis infection, because of positive results in interferon-γ release assays. The patient's fever and malaise promptly disappeared, and his renal function improved. After the patient had been discharged, Mycobacterium intracellulare grew in cultures of his renal tissue and urine. We gradually reduced the dose of PSL; we initiated combination therapy with ethambutol, clarithromycin, and rifampin. After 2 years of follow-up, the patient continued treatment for chronic kidney disease; it has since enabled him to avoid renal replacement therapy. This report describes a rare instance of nontuberculous mycobacteria-associated tubulointerstitial nephritis in a patient without a history of HIV infection or organ transplantation. In differential diagnosis of granulomatous tubulointerstitial nephritis, clinicians should consider drugs, sarcoidosis, tubulointerstitial nephritis and uveitis syndrome, vasculitis, and infections (e.g., involving mycobacteria). Prompt microbiological examinations, especially of urine or biopsy cultures, are vital for diagnosis.

Original languageEnglish
Pages (from-to)442-447
Number of pages6
JournalCEN case reports
Volume11
Issue number4
DOIs
Publication statusPublished - Nov 1 2022

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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