{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:22:28Z","timestamp":1787728948275,"version":"build-2784847793"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004721","name":"The University of Tokyo","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004721","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["CEN Case Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Tosufloxacin, a fluoroquinolone antibiotic, is increasingly prescribed for pediatric patients, particularly for macrolide-resistant <jats:italic>Mycoplasma pneumoniae<\/jats:italic> infections in Japan. While its efficacy is well-documented, adverse effects such as renal impairment and gastrointestinal symptoms have raised growing concerns. We report a case of a 10-year-old girl who developed sequential symptoms following tosufloxacin administration. On the day after starting tosufloxacin, she experienced right-sided flank pain, followed by the onset of gastrointestinal symptoms, including abdominal pain, diarrhea, and vomiting, on the subsequent day. Contrast-enhanced computed tomography revealed increased fatty tissue opacity surrounding the kidney and duodenal wall thickening, suggestive of localized inflammation extending from the kidney to adjacent structures. Urine microscopy demonstrated needle- and sea urchin-shaped drug crystals, strongly implicating tosufloxacin in the development of renal and gastrointestinal symptoms. This case provides the first evidence suggesting that kidney inflammation may contribute to gastrointestinal symptom onset via localized inflammatory extension. The patient\u2019s symptoms resolved promptly with the discontinuation of tosufloxacin and supportive care. This report underscores the importance of monitoring pediatric patients for renal and gastrointestinal adverse effects following tosufloxacin administration.<\/jats:p>","DOI":"10.1007\/s13730-025-01007-z","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T11:29:07Z","timestamp":1750159747000},"page":"713-718","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Renal and gastrointestinal complications following tosufloxacin therapy for suspected mycoplasma infection in a 10-year-old child"],"prefix":"10.1007","volume":"14","author":[{"given":"Shigehiro","family":"Sainokami","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirofumi","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6674-1221","authenticated-orcid":false,"given":"Shoichiro","family":"Kanda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natsuho","family":"Adachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Takizawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoko","family":"Sone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Kajiho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiko","family":"Kinumaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshifumi","family":"Morita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teruhiko","family":"Yoshida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Kurano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Harita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"1007_CR1","first-page":"751","volume":"68","author":"K Nagata","year":"2019","unstructured":"Nagata K, Tanaka Y, Matsumoto M, Hashimoto A, Yamaguchi F, Nakagawa S, et al. Characteristics of tosufloxacin crystals and crystal casts observed in urine sediment of infants. Jpn J Med Technol. 2019;68:751\u20137.","journal-title":"Jpn J Med Technol"},{"key":"1007_CR2","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1007\/s10157-013-0856-y","volume":"18","author":"O Uemura","year":"2014","unstructured":"Uemura O, Nagai T, Ishikura K, Ito S, Hataya H, Gotoh Y, et al. Creatinine-based equation to estimate the glomerular filtration rate in Japanese children and adolescents with chronic kidney disease. Clin Exp Nephrol. 2014;18:626\u201333.","journal-title":"Clin Exp Nephrol"},{"key":"1007_CR3","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.2147\/TCRM.S168696","volume":"14","author":"S Oyama","year":"2018","unstructured":"Oyama S, Hosohata K, Inada A, Niinomi I, Mori Y, Yamaguchi Y, et al. Drug-induced tubulointerstitial nephritis in a retrospective study using spontaneous reporting system database. Ther Clin Risk Manag. 2018;14:1599\u2013604.","journal-title":"Ther Clin Risk Manag"},{"key":"1007_CR4","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1016\/S0272-6386(04)01089-3","volume":"44","author":"H Okada","year":"2004","unstructured":"Okada H, Watanabe Y, Kotaki S, Ikeda N, Takane H, Kanno Y, et al. An unusual form of crystal-forming chronic interstitial nephritis following long-term exposure to tosufloxacin tosilate. Am J Kidney Dis. 2004;44:902\u20137.","journal-title":"Am J Kidney Dis"},{"key":"1007_CR5","doi-asserted-by":"publisher","first-page":"2833","DOI":"10.2169\/internalmedicine.3082-23","volume":"63","author":"Y Ito","year":"2024","unstructured":"Ito Y, Mori N, Matsuo K, Tanaka S, Mori K, Kobayashi N, et al. Evidence of Tosufloxacin deposition in the kidneys of a patient presenting with crystal nephropathy. Intern Med. 2024;63:2833\u20137.","journal-title":"Intern Med"},{"key":"1007_CR6","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1111\/ped.13116","volume":"58","author":"R Matsubara","year":"2016","unstructured":"Matsubara R, Kibe T, Nomura T. Crystalline nephropathy caused by tosufloxacin. Pediatr Int. 2016;58:1219\u201321.","journal-title":"Pediatr Int"},{"key":"1007_CR7","doi-asserted-by":"publisher","DOI":"10.1111\/ped.15368","volume":"64","author":"Y Atsumi","year":"2022","unstructured":"Atsumi Y, Yamanaka H, Shimozawa K, Yamanaka J, Uryu H, Mizukami A, et al. Drug-induced crystalluria attributable to tosufloxacin in children. Pediatr Int. 2022;64: e15368.","journal-title":"Pediatr Int"},{"key":"1007_CR8","first-page":"30","volume":"31","author":"N Sugawara","year":"2018","unstructured":"Sugawara N, Yamamura S, Takahashi A, Tazawa S, Kubota Y, Ozawa K, et al. Adverse renal effects and serum creatinine elevation associated with tosufloxacin. Jpn J Ped Nephrol. 2018;31:30\u20136.","journal-title":"Jpn J Ped Nephrol"},{"key":"1007_CR9","first-page":"643","volume":"93","author":"T Tajima","year":"2020","unstructured":"Tajima T, Miyashita H, Mieno K, Sato Y, Shibuya Ykoyama S, et al. Acute Kidney Injury after Administration of Tosufloxacin Tosilate in Children with Mycoplasma pneumoniae Pneumoni. Jpn J Infect Dis. 2020;93:643\u20138.","journal-title":"Jpn J Infect Dis"}],"container-title":["CEN Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13730-025-01007-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13730-025-01007-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13730-025-01007-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T13:22:51Z","timestamp":1758720171000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13730-025-01007-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":9,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["1007"],"URL":"https:\/\/doi.org\/10.1007\/s13730-025-01007-z","relation":{},"ISSN":["2192-4449"],"issn-type":[{"value":"2192-4449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,17]]},"assertion":[{"value":"26 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have declared that no conflict of interest exists.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and animals"}},{"value":"The patient and their legal guardian have provided written informed consent for the publication of this case report, including all relevant clinical details and any accompanying images.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}