The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e1 

Suspected Doxycycline Induced Acute 
Interstitial Nephritis 
Andrew Abrahamian, MD1*, Cameron Burmeister, MD1, Srini Hejeebu, DO1 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 

*Corresponding author: andrew.abrahamian@utoledo.edu

Published: 05 May 2023 

Introduction:  This report describes a case of a patient presenting with diabetic ketoacidosis who 
experienced progressively worsening acute kidney injury after exposure to multiple nephrotoxic agents 
during hospital course. The patient’s presentation led to a relatively broad differential for acute kidney 
injury (AKI), which included contrast-induced nephropathy, vancomycin-induced nephrotoxicity, and 
interstitial nephritis secondary to antibiotic use. Interstitial nephritis associated with doxycycline use is 
poorly described in the literature, which delayed cessation of suspected offending agent. 

Case Presentation:  A 28-year-old male with past medical history of diabetes mellitus type 2 presented 
with diabetic ketoacidosis. On admission, patient underwent CT neck with contrast for evaluation of 
cellulitis and was placed on empiric antibiotic therapy (vancomycin, piperacillin-tazobactam and 
metronidazole). Patient was later transitioned to oral doxycycline. Within 24 hours of starting 
doxycycline, the patient developed AKI. Despite fluid resuscitation and oral prednisone, the patient’s 
kidney function rapidly worsened. Doxycycline was discontinued, and 48 hours after the last dose, renal 
function began to steadily improve. Electron microscopy findings from renal biopsy exhibited severe 
acute interstitial nephritis. 

Discussion:  Pathology findings confirm acute interstitial nephritis, ruling out other potential causes 
including contrast-induced nephropathy and vancomycin-induced tubular necrosis. The patient 
experienced a decline in renal function less than 7 days from introduction of an offending agent, which 
would indicate a repeat exposure. The patient received doxycycline in the week prior to admission. 
Drug-induced acute interstitial nephritis characteristically improves after withdraw of the offending 
drug. Doxycycline was the only agent for which kidney function improved after withdraw. 

https://dx.doi.org/10.46570/utjms.vol11-2023-635 

https://dx.doi.org/10.46570/utjms.vol11-2023-635
mailto:andrew.abrahamian@utoledo.edu