QuestionSBA
QuestionChoice
This would typically present with fevers, weight loss, flank pain and haematuria rather than the triad of fever, rash and eosinophilia classically seen in AIN.
10028390
e
Renal cell carcinoma
QuestionChoice
This patient has presented with the classic triad of AIN; fever, rash and eosinophilia in a setting of decreased renal function. Beta-lactam antibiotics can commonly trigger AIN.
10028386
a
Acute interstitial nephritis
QuestionChoice
This is caused by nephrotoxic or ischaemic damage to the renal tubules and typically presents with hypotension and oliguria. Additionally, you would not expect to see the systemic symptoms or presence of eosinophilia.
10028387
b
Acute tubular necrosis
QuestionChoice
Whilst a red, hot and swollen joint should raise suspicion for septic arthritis, it is rarely polyarticular and the pain is described as mild with preserved range of motion. Additionally, it would not explain the eosinophilia and presence of a rash.
10028388
c
Septic arthritis
QuestionChoice
This may present with oedema and be seen in other signs of poor diabetic control (e.g. persistent hyperglycaemia, presence of neuropathy). Additionally, it would not explain the rash, joint pain or eosinophilia. AIN is a far more likely diagnosis in this case despite the past medical history of diabetes.
10028389
d
Diabetic nephropathy
Concept
Chapter
2693
6058
Acute interstitial nephritis
Topic
142
Nephrology
18075
Acute interstitial nephritis often presents with fever, rash, eosinophilia, and renal impairment, commonly triggered by beta-lactam antibiotics.
A 67-year-old female with a history of diabetes has a widespread maculopapular rash, fever and polyarticular joint pain.

On examination, her joints are swollen and mildly tender, with range of motion preserved.

Her blood tests show an elevated eosinophil count and raised creatinine, compared to previous results

She has recently completed a course of co-amoxiclav for an upper UTI.

What is the most likely diagnosis?
a