Acute interstitial nephritis due to Ciclosporin a toxicity during Behçet's disease

Introduction : Ciclosporin A is an immunosuppressive molecule widely used in Behçet’s disease (BD), especially for severe ocular and/or neurological disorders. Its particular toxicity in this field has, however, largely limited its use during this vasculitis. We report an aspect. Case report : 26-year-old patient followed since the age of 20 for BD with severe ocular involvement (bilateral posterior steroid-resistant uveitis with a significant decrease in visual acuity) requiring treatment with Ciclosporin A at a dose of 5mg/kg/twice daily during the first month and then 5mg/kg/day as a maintenance dose to control uveitis. The one-year control report noted a creatinine at 147μmol/l with aseptic leucocyturia at 400 elements/l. blood pressure was normal and there was no associated hematuria or proteinuria. The infectious and toxic investigation was normal. The ultrasound showed two kidneys of normal size and echo-structure. Renal biopsy revealed acute interstitial nephritis with images of toxic tubular necrosis. Cyclosporine was discontinued and replaced with azathioprine. Renal function normalized three weeks after stopping the molecule. Conclusion : periodic and regular monitoring of renal function (blood and urine tests) is strongly recommended in order to detect renal damage early in the BD; especially if Ciclosporin A treatment.