Acetaminophen overdose and alcohol intoxication in a 17 year
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Drug-induced acute interstitial nephritis (AIN) represents a common cause of renal injury in today's medical practice. AIN is characterized by cellular infiltration of the interstitium (including CD4+ T cells, macrophages, eosinophils and plasma cells) and is accompanied by interstitial edema in the absence of glomerular or capillary damage. The majority of AIN cases have been linked to the use of antimicrobials and non-steroidal anti-inflammatory drugs (NSAIDs); however the number of drugs implemented in AIN pathogenesis continues to expand.

Animal models of drug-induced AIN provide evidence for an immune-mediated mechanism of disease. On the basis of observed cellular infiltrate composition and physiological signs (fever, malaise, rash, eosinophilia and arthralgia), a T-cell mediated delayed hypersensitivity reaction has been proposed. In this model, drugs are assumed to elicit reactions targeted to endogenous renal antigens through a hapten-like manner or through native renal protein imitation.

The following report describes a patient who experienced AIN after consumption of high doses of acetaminophen with concomitant acute alcohol intoxication. While hepatic and renal toxicity have been well associated with acetaminophen overdose, few reports have been documented on the involvement of the analgesic in AIN onset. Of the few cases reported, most patients, if not all, have also suffered from chronic alcoholism. The documentation of AIN associated with acetaminophen overdose and acute alcohol ingestion is unprecedented. Thus, the purpose of our report is to increase awareness of the potential adverse affects of acetaminophen overdose; even in the case of acute alcohol consumption....