Tohoku J. Exp. Med., 2018 July, 245(3)

Infliximab-Induced Tubulointerstitial Nephritis with Image Findings of Striated Nephrogram in Crohn's Disease

TOMONORI SATO,¹ YOSHIHIDE KAWASAKI,¹ AKIHIRO ITO,¹ HIDEAKI IZUMI,¹ NAOKI KAWAMORITA,¹ SHINICHI YAMASHITA,¹ KOJI MITSUZUKA,¹ TOMONORI MATSUURA,² MIKA WATANABE³ and YOICHI ARAI¹

¹Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
²Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
³Division of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan

Tubulointerstitial nephritis is primary injury to renal tubules and interstititum which could be resulting in decreased renal function. The acute and chronic forms are most often due to allergic drug reactions or to infections. Tubulointerstitial nephritis in Crohn's disease has rarely been reported. Imaging findings of a striated nephrogram on enhanced computed tomography (CT) could represent the clinical state of tubulointerstitial nephritis. This is the first report of tubulointerstitial nephritis caused by infliximab, monoclonal antibody against human tumor necrosis factor-α, showing striated nephrograms in Crohn's disease. The case of a 28-year-old man treated with infliximab for Crohn's disease is described. Infliximab was added to his maintenance therapy, and bowel symptoms were stable. The patient presented with a 2-month history of fever and an elevated C-reactive protein after infliximab administration for 4.5 years. Contrast-enhanced CT showed striated nephrograms in both kidneys. Urinalysis showed no abnormal findings. The pathological diagnosis on CT-guided percutaneous renal needle biopsy was drug-induced tubulointerstitial nephritis because of eosinophilic infiltration with neutrophils mainly in the tubulointerstitial areas. The imaging findings of striated nephrogram are important for the diagnosis of tubulointerstitial nephritis. Tubulointerstitial nephritis could be caused by drug-induced inflammation or direct extension of Crohn's disease as an extra-interstitial manifestation. The treatment strategies for these two diseases are contradictory to each other and inappropriate treatment could worsen the renal function. Needle biopsy is therefore indispensable for differential diagnosis.

keywords —— Crohn's disease; infliximab; renal biopsy; striated nephrogram; tubulointerstitial nephritis

© 2018 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2018, 245, 149-152

Correspondence: Yoshihide Kawasaki, M.D., Department of Urology, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

e-mail: kawasaki@uro.med.tohoku.ac.jp