Tubulointerstitial Nephritis with Uveitis Syndrome following Varicella Zoster Reactivation

Dragan Ljutić, Meri Glavina
1995 Nephron  
cal and immunological investigations were normal or negative. Urinalysis showed gly-cosuria (normoglycemic), ß2-microglobulin-uria (68 mg/day), and proteinuria of 700 mg/ day with glomerular casts. Urine cultures were sterile. HLA typing showed: HLA-A1, HLA-A2, HLA-B16, and HLA-DR14. Chest X-ray, skeletal X-ray, renal ultrasound, and bone marrow biopsy were normal. Renal biopsy revealed interstitial edema and diffuse cell infiltration with lymphocytes, plas-macytes, neutrophils and eosinophils
more » ... fig. 1 ). There were no glomerular or vascular abnor-Dear Sir, Acute tubulointerstitial nephritis with uveitis (TINU) syndrome is a relatively new syndrome first described in children, and more recently in adults [1]. To our knowledge only 15 cases of this entity in adults have been reported so far. In all of them there were no history, clinical or laboratory findings of previous bacterial, viral or collagen vascular disease. We describe here a patient with a TINU syndrome in whom a herpes zoster preceded the full clinical picture. A 49-year-old woman was referred to the Renal Unit because of azotemia and fatigue. Two months earlier, she had had herpes zoster located on the right Til dermatome. Twenty days after skin eruption, iridocyclitis of the left, and a week later of the right eye were diagnosed and successfully treated. During that time she had general malaise, fatigue, anorexia, and mild fever. The eryth-rocyte sedimentation rate (ESR) was 106 mm/h, serum creatinine 154µmol/l, total protein 85.5 g/l, IgG 20.8 g/l, IgA 6.8 g/l, and circulating immune complexes 0.180 g/l. Serology revealed previous cytomegalo-, Ep-stein-Barr, herpes simplex, and varicella zoster virus infections. Because of an increment of creatinine over the following 3 weeks, she was referred to our unit.
doi:10.1159/000188782 pmid:8587642 fatcat:ggb2csjc6zhb5ghtoib46re53m