A case of acute interstitial nephritis and granulomatous hepatitis induced by ingesting quinine

Abstract

Quinine is used for the treatment of malarial infection, though not in common use. It is especially valuable for the parenteral treatment of severe illness owing to drug-resistant strains of Plasmodium falciparum. Quinine is also known to occasionally cause acute renal failure (ARF). Although quinine is listed in some reviews as a cause of acute interstitial nephritis, most cases of quinine-associated acute renal failure have been attributed to the hemolytic-uremic syndrome (HUS). Only two cases of acute renal failure due to acute interstitial nephritis associated with quinine have been reported [1, 2]. To our knowledge, there have been 6 reported cases of quinine-induced hepatic granuloma [3-8]. We report a case of quinine-induced acute interstitial nephritis (AIN) along with granulomatous hepatitis, both of which were confirmed on biopsy. A 50-year-old Nigerian man was admitted to the hospital with complaints of fever and general fatigue. He had been prescribed quinine as an antimalarial drug in a Nigerian hospital. The patient was febrile and showed nonoliguric ARF and liver dysfunction. In this case, liver injury showed gradual and spontaneous resolution after discontinuing quinine, and ARF resolved after treatment with oral prednisolone.

Keywords: Acute interstitial nephritis; Acute renal failure; Biopsy; Hepatic granuloma; Quinine.

Fig. 1

Light microscopic findings of liver biopsy. Epithelioid cell granuloma (arrows) and mild neutrophil infiltration (hematoxylin and eosin stain, ×400)

Fig. 2

Light microscopic findings of renal biopsy. Renal biopsy demonstrates diffuse interstitial inflammatory infiltration actively invading the tubules. Most glomeruli and vessels appear uninvolved (Periodic acid Schiff stain, ×400)

Fig. 3

Clinical course. In this case, ARF resolved gradually after discontinuing quinine