{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T17:28:35Z","timestamp":1784741315697,"version":"3.55.0"},"reference-count":44,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T00:00:00Z","timestamp":1649894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Background. Drug-induced lupus (DIL) is an autoimmune phenomenon where the patient develops lupus-like symptoms after exposure to a long-term medication. Case Summary. Here we describe a 10-year-old female with absence seizures who developed a lupus-like syndrome after being on ethosuximide for three months. She presented with nephrotic syndrome (NS) and acute kidney injury. Four weeks prior to presentation, she had been prescribed a seven-day course of oral amoxicillin for submental swelling after dental extraction. Investigations showed high titer of antinuclear antibody (ANA) and anti-double stranded DNA, elevated serum IgE level, and positive Coombs\u2019 test, along with positive anti-histone antibodies. Renal biopsy showed features of acute tubulointerstitial nephritis (TIN) and partial podocyte foot process effacement without evidence of lupus nephritis. The patient had an excellent response to the steroid therapy with remission within two weeks. The patient remained in remission for two months as evaluated during the most recent follow-up; the autoimmune antibodies and immunoglobulin E trended down. Ethosuximide has been reported to cause DIL, however its possible association with TIN has not been reported. Although amoxicillin could have caused the TIN and NS in this patient, a possible novel association of ethosuximide with this nephrotic-nephritic presentation (NNP) cannot be ruled out. Conclusions. A renal histology is important to determine the accurate etiology of NNP in patients with DIL. Further studies are necessary to determine any possible causal effect of ethosuximide with NNP.<\/jats:p>","DOI":"10.3390\/pediatric14020026","type":"journal-article","created":{"date-parts":[[2022,4,19]],"date-time":"2022-04-19T01:03:01Z","timestamp":1650330181000},"page":"190-199","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Drug-Induced Lupus Secondary to Ethosuximide in Association with Acute Tubulointerstitial Nephritis and Nephrotic Syndrome"],"prefix":"10.3390","volume":"14","author":[{"given":"Rasha","family":"Aly","sequence":"first","affiliation":[{"name":"Division of Pediatric Nephrology, Department of Pediatrics, University of Florida, Gainesville, FL 32608, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Zeng","sequence":"additional","affiliation":[{"name":"Division of Anatomic Pathology, Department of Pathology, University of Florida, Gainesville, FL 32608, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8441-0220","authenticated-orcid":false,"given":"Kiran","family":"Upadhyay","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology, Department of Pediatrics, University of Florida, Gainesville, FL 32608, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1097\/00002281-199909000-00006","article-title":"Etiology and mechanisms of drug-induced lupus","volume":"11","author":"Rubin","year":"1999","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1067\/mjd.2001.116583","article-title":"Drug-induced cutaneous lupus erythematosus, a distinct syndrome that is frequently under-recognized","volume":"45","author":"Callen","year":"2001","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1093\/ndt\/gfu326","article-title":"Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury","volume":"30","author":"Praga","year":"2015","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1001\/jama.1954.73690350001010","article-title":"Lupus erythematosus-like syndrome complicating hydralazine (apresoline) therapy","volume":"155","author":"Reinhardtb","year":"1954","journal-title":"J. Am. Med. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1196\/annals.1422.019","article-title":"Drug-induced lupus","volume":"1108","author":"Borchers","year":"2007","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1517\/14740338.2015.995089","article-title":"Drug-induced lupus","volume":"14","author":"Rubin","year":"2015","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.2215\/CJN.01910215","article-title":"Drug-induced glomerular disease: Immune-mediated injury","volume":"10","author":"Hogan","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1136\/ard.2004.024182","article-title":"Autoantibody formation in patients with rheumatoid arthritis treated with anti-TNF alpha","volume":"64","author":"Eriksson","year":"2005","journal-title":"Ann. Rheum. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1111\/j.1445-5994.1982.tb03845.x","article-title":"Cardiac tamponade in hydralazine-induced systemic lupus erythematosus","volume":"12","author":"Aylward","year":"1982","journal-title":"Aust. N. Z. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/0009-9120(92)90354-U","article-title":"Autoantibody specificity in drug-induced lupus and neutrophil-mediated metabolism of lupus-inducing drugs","volume":"25","author":"Rubin","year":"1992","journal-title":"Clin. Biochem."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.autrev.2018.03.016","article-title":"Drug-induced lupus: Traditional and new concepts","volume":"17","author":"Vaglio","year":"2018","journal-title":"Autoimmun Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"R545","DOI":"10.1186\/ar1715","article-title":"Club Rhumatismes et Inflammation. Systemic lupus erythematosus induced by anti-tumour necrosis factor alpha therapy: A French national survey","volume":"7","author":"Sibilia","year":"2005","journal-title":"Arthritis Res. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1159\/000167072","article-title":"Antibiotic-associated interstitial nephritis and nephrotic syndrome","volume":"6","author":"Baum","year":"1986","journal-title":"Am. J. Nephrol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1080\/00325481.1985.11698908","article-title":"Drug-induced systemic lupus erythematosus. Differentiating it from the real thing","volume":"77","author":"Kale","year":"1985","journal-title":"Postgrad. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.tox.2004.12.025","article-title":"Drug-induced lupus","volume":"209","author":"Rubin","year":"2005","journal-title":"Toxicology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/S0140-6736(80)91554-8","article-title":"Hydralazine-induced systemic lupus erythematosus: Influence of HLA-DR and sex on susceptibility","volume":"1","author":"Batchelor","year":"1980","journal-title":"Lancet"},{"key":"ref_17","first-page":"845","article-title":"Hydralazine sensitivity: Clinical features, autoantibody changes and HLA-DR phenotype","volume":"65","author":"Russell","year":"1987","journal-title":"Q. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/S0140-6736(89)92506-3","article-title":"Complement system protein C4 and susceptibility to hydralazine-induced systemic lupus erythematosus","volume":"1","author":"Speirs","year":"1989","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1042\/bj2590415","article-title":"Inhibition of the covalent binding reaction of complement component C4 by penicillamine, an antirheumatic agent","volume":"259","author":"Sim","year":"1989","journal-title":"Biochem. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/S0140-6736(84)92905-2","article-title":"Drugs that induce systemic lupus erythematosus inhibit complement component C4","volume":"2","author":"Sim","year":"1984","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1172\/JCI114020","article-title":"Metabolism of procainamide to the cytotoxic hydroxylamine by neutrophils activated in vitro","volume":"83","author":"Rubin","year":"1989","journal-title":"J. Clin. Investig."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1177\/0961203306070000","article-title":"Drug-induced lupus: An update","volume":"15","author":"Vasoo","year":"2006","journal-title":"Lupus"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"413","DOI":"10.5414\/CNP73413","article-title":"Acute tubulointerstitial nephritis related to antituberculous drug therapy","volume":"73","author":"Schubert","year":"2010","journal-title":"Clin. Nephrol."},{"key":"ref_24","first-page":"97","article-title":"Allergic interstitial nephritis: Clinical features and pathogenesis","volume":"66","author":"Cameron","year":"1998","journal-title":"Q. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1681\/ASN.V93506","article-title":"Acute interstitial nephritis","volume":"9","author":"Michel","year":"1998","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"809","DOI":"10.3109\/08860229809045178","article-title":"Drug-induced acute interstitial nephritis","volume":"20","author":"Alexopoulos","year":"1998","journal-title":"Ren. Fail."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"J266","DOI":"10.1016\/j.jaut.2009.11.012","article-title":"Drugs and autoimmunity: A contemporary review and mechanistic approach","volume":"34","author":"Chang","year":"2010","journal-title":"J. Autoimmun."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jaut.2014.01.005","article-title":"Diagnosis, and classification of drug-induced autoimmunity (DIA)","volume":"48\u201349","author":"Xiao","year":"2014","journal-title":"J. Autoimmun."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"381","DOI":"10.5414\/CN108301","article-title":"Diagnosing drug-induced AIN in the hospitalized patient: A challenge for the clinician","volume":"81","author":"Perazella","year":"2014","journal-title":"Clin. Nephrol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1159\/000182077","article-title":"Acute interstitial nephritis due to amoxicillin therapy","volume":"27","author":"Appel","year":"1981","journal-title":"Nephron"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1159\/000071111","article-title":"Amoxicillin-induced nephritis and tubulitis in a child","volume":"71","author":"Ferrara","year":"2003","journal-title":"Urol. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1038\/ki.2010.89","article-title":"Acute interstitial nephritis","volume":"77","author":"Praga","year":"2010","journal-title":"Kidney Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/BF01972897","article-title":"Renal tubular dysfunction following treatment with anti-epileptic drugs","volume":"153","author":"Korinthenberg","year":"1994","journal-title":"Eur. J. Pediatr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/S0387-7604(02)00007-4","article-title":"Tubulo-interstitial nephritis caused by sodium valproate","volume":"24","author":"Yoshikawa","year":"2002","journal-title":"Brain Dev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/S0300-2977(96)00070-8","article-title":"Carbamazepine-associated acute tubulointerstitial nephritis","volume":"50","author":"Eijgenraam","year":"1997","journal-title":"Neth. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"32976","DOI":"10.3402\/jchimp.v6.32976","article-title":"A rare case of lamotrigine-induced acute interstitial nephritis","volume":"6","author":"Matta","year":"2016","journal-title":"J. Community Hosp. Intern. Med. Perspect."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1111\/sdi.12385","article-title":"Use of antiepileptic drugs in patients with chronic kidney disease and end stage renal disease","volume":"28","author":"Bansal","year":"2015","journal-title":"Semin. Dial."},{"key":"ref_38","first-page":"57","article-title":"Drug-induced renal disorders","volume":"4","author":"Assadi","year":"2015","journal-title":"J. Renal. Inj. Prev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.2215\/CJN.00860115","article-title":"Drug-induced glomerular disease: Direct cellular injury","volume":"10","author":"Markowitz","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.2215\/CJN.08090719","article-title":"NSAIDs and Nephrotic Syndrome","volume":"14","author":"Praga","year":"2019","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/S0272-6386(12)70328-1","article-title":"Ranitidine-induced acute interstitial nephritis with epithelial cell foot process fusion","volume":"22","author":"Gaughan","year":"1993","journal-title":"Am. J. Kidney Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1056\/NEJM198403013100905","article-title":"Renal syndromes associated with nonsteroidal antiinflammatory drugs","volume":"310","author":"Clive","year":"1984","journal-title":"N. Engl. J. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1159\/000166685","article-title":"Rifampin-induced nephrotic syndrome and acute interstitial nephritis","volume":"3","author":"Neugarten","year":"1983","journal-title":"Am. J. Nephrol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1038\/ki.2008.356","article-title":"Bisphosphonate nephrotoxicity","volume":"74","author":"Perazella","year":"2008","journal-title":"Kidney Int."}],"container-title":["Pediatric Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7503\/14\/2\/26\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:54:19Z","timestamp":1760136859000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7503\/14\/2\/26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,14]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["pediatric14020026"],"URL":"https:\/\/doi.org\/10.3390\/pediatric14020026","relation":{},"ISSN":["2036-7503"],"issn-type":[{"value":"2036-7503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,14]]}}}