Macroscopic amoxicillin crystalluria
Résumé
, with fever, arthralgia, and dyspnoea lasting for 6 days. Her medical history was uneventful apart from hypertension and active tobacco use. Her glomerular filtration rate at admission was 82 mL/min per 1•73 m² (normal range ≥90 mL/min per 1•73 m²). Blood cultures on admission grew Streptococcus agalactiae and acute aortic infective endocarditis was rapidly diagnosed with transoesophageal echocardiography. She was immediately started on high-dose intravenous amoxicillin (200 mg/kg per day) with intravenous gentamicin (240 mg once-daily). After 4 days, we noticed cloudy urine, with a thin granular appearance (figure). Her urine pH was 5•5. Direct examination of the urine showed amoxicillin crystalluria with large, typically aggregated needle-shaped crystals (figure) that were birefringent under polarised light microscopy. Her clinical condition worsened with oliguria, acute renal failure, and pulmonary oedema within 24 h. An aortic ring abscess was evident on a second echocardiography. After emergency valve replacement surgery and renal replacement therapy, she recovered well and was discharged home in October, 2013, without further renal replacement therapy, and with improving renal function. Her last glomerular filtration rate was 45 mL/min per 1•73 m² in March, 2014. At last follow-up,
Domaines
Sciences du Vivant [q-bio]
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