A 30-year-old woman with no previous medical history presented to the emergency department with a seizure and aggressive behavior. After extensive blood work and imaging studies, she was admitted with HIV inaugural infection (CDC stage C3) and cerebral toxoplasmosis. As the first line of treatment, the patient was started on sulfadiazine and pyrimethamine11. Elsheikha HM, Marra CM, Zhu XQ. Epidemiology, pathophysiology, diagnosis, and management of cerebral toxoplasmosis. Clin Microbiol Rev. 2020;34(1):e00115–19. doi: http://dx.doi.org/10.1128/CMR.00115-19. PubMed PMID: 33239310.
https://doi.org/10.1128/CMR.00115-19...
,22. Perazella MA, Herlitz LC. The crystalline nephropathies. Kidney Int Rep. 2021;6(12):2942–57. doi: http://dx.doi.org/10.1016/j.ekir.2021.09.003. PubMed PMID: 34901567.
https://doi.org/10.1016/j.ekir.2021.09.0...
,33. Chebion G, Bugni E, Gerin V, Daudon M, Castiglione V. Drug-induced nephrolithiasis and crystalluria: the particular case of the sulfasalazine derivatives. C R Chim. 2022;25(S1):295–306. doi: http://dx.doi.org/10.5802/crchim.109.
https://doi.org/10.5802/crchim.109...
. After one week, she developed non-oliguric acute kidney injury. Urinary sediment analysis revealed sulfonamide crystals with the morphologic appearance of shocks of wheat (Figures 1 and 2), confirmed by infrared spectroscopy4. Sulfadiazine was replaced with clindamycin, and a notable enhancement was observed after to the implementation of vigorous fluid hydration using an alkaline solution (sodium bicarbonate).
Acknowledgments
We thank Dr. Vincent Frochot for the infrared spectroscopy analysis.
References
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1.Elsheikha HM, Marra CM, Zhu XQ. Epidemiology, pathophysiology, diagnosis, and management of cerebral toxoplasmosis. Clin Microbiol Rev. 2020;34(1):e00115–19. doi: http://dx.doi.org/10.1128/CMR.00115-19. PubMed PMID: 33239310.
» https://doi.org/10.1128/CMR.00115-19 -
2.Perazella MA, Herlitz LC. The crystalline nephropathies. Kidney Int Rep. 2021;6(12):2942–57. doi: http://dx.doi.org/10.1016/j.ekir.2021.09.003. PubMed PMID: 34901567.
» https://doi.org/10.1016/j.ekir.2021.09.003 -
3.Chebion G, Bugni E, Gerin V, Daudon M, Castiglione V. Drug-induced nephrolithiasis and crystalluria: the particular case of the sulfasalazine derivatives. C R Chim. 2022;25(S1):295–306. doi: http://dx.doi.org/10.5802/crchim.109.
» https://doi.org/10.5802/crchim.109 -
4.Fogazzi GB. The urinary sediment: an integrated view. 3rd ed. Milan: Elsevier; 2010. p. 159–61.
Publication Dates
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Publication in this collection
10 May 2024 -
Date of issue
Oct-Dec 2024
History
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Received
08 Oct 2023 -
Accepted
22 Mar 2024