A 48-Year-Old Man Comes to the Emergency Department Due to Fever

question 37

Multiple Choice

A 48-year-old man comes to the emergency department due to fever and cellulitis of the distal right lower extremity.  He was initially seen in a clinic 2 days earlier and treated with oral clindamycin, but he subsequently developed increasing erythema.  Medical history is notable for nondeforming rheumatoid arthritis treated with hydroxychloroquine and a similar episode of cellulitis 2 years ago that resolved with a course of cefazolin.  The patient is admitted to the hospital and treated with cefazolin and leg elevation.  His fever rapidly resolves and the area of erythema recedes.  However, 3 days after admission, serum creatinine increases from 1.2 to 1.9 mg/dL.
Urinalysis results are as follows:
Urine stain for eosinophils is negative.
Which of the following is the most likely diagnosis in this patient?

• A)Acute interstitial nephritis
• B)Immune complex glomerulonephritis
• C)Prerenal acute kidney injury
• D)Renal vasculitis
• E)Rheumatoid involvement of the kidney

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