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Clinical Images

Acute Interstitial Nephritis and Rash in the Setting of Volume Overload

Lucy S. Witt, MD MPH; E. Allen Liles, MD; John R. Stephens, MD

October 14, 2015

A 49 year-old man presented in atrial fibrillation with rapid ventricular response. He was diuresed with furosemide and subsequently suffered a severe progressive erythematous rash and acute interstitial nephritis (Figure 1).


acute nepg


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1.  Cohen B. Pediatric Dermatology. 7 ed. Elsevier Limited; 2013: 169-210
2.  Ives HE. Chapter 15. Diuretic Agents. In: Katzung BG, Masters SB, Trevor AJ.eds. Basic & Clinical Pharmacology, 12e. New York, NY: McGraw-Hill; 2012. Accessed April 21, 2015.
3.  Rossert J. Drug-induced acute interstitial nephritis.  Kidney Int. 2001;60:804-17.
4.  Perazella MA, Markowitz GS. Drug-induced acute interstitial nephritis.  Nat Rev Nephrol. 2010;6:461-70.
5.  Phipatanakul W, Adkinson NF, Jr. Cross-Reactivity Between Sulfonamides and Loop or Thiazide Diuretics: Is it a Theoretical or Actual Risk? Allergy Clin Immunol Int. 2000;12(1):26-8. 
6.  Wright AA, Vesta KS, Stark JE, Smith WJ. Stevens-Johnson syndrome associated with furosemide: a case report.  J Pharm Pract. 2010;23:367-70.

About the Authors: 

Lucy S. Witt, MD, MPH
Resident Physician, University of North Carolina at Chapel Hill Internal Medicine Residency 

E. Allen Liles, MD 
Director, UNC Hospital Medicine Program
Section Chief for Inpatient Education and Practice, Internal Medicine
University of North Carolina at Chapel Hill