Eosinophilia NSAIDs

Allergic interstitial nephritis Penicillins, rifampin, sulfonamides, thiazides, cimetidine.phenytoin, allopurinol, furosemide, NSAIDS, ciprofloxacin, pantoprazole, omeprazole, atazanavir, bevacizumab Rash, fever, eosinophilia, eosinophiluria, pyuria... 

Pulmonary infiltrates with eosinophilia (Loeffler s syndrome) have been associated with nitrofurantoin,para-aminosalicytic acid, methotrexate, sulfonamides, tetracycline, chlorpropamide, phenytoin, NSAIDs, and imipramine (Table 29-5). The disorder is characterized by fever, nonproductive cough, dyspnea, cyanosis, bilateral pulmonary infiltrates, and eosinophilia in the blood. Lung biopsy has revealed perivasculitis with infiltration of eosinophils, macrophages, and proteinaceous edema fluid in the alveoli. The symptoms and eosinophilia generally respond rapidly to withdrawal of the offending drug. 

NSAIDs also have been associated with pulmonary infiltrates and eosinophilia (PIE) syndrome. This syndrome is associated with fever, cough, dyspnea, infiltrates on chest roentgenogram, and a peripheral eosinophilia that develop 2 to 6 weeks after initiating treatment. PIE syndrome occurs more frequently for naproxen compared with other NSAIDs and is noted to resolve rapidly after discontinuation of the offending agent. ... 

NSAlD-induced AIN has a different clinical presentation than that seen with most other drugs (Rossert 2001 Perazella 2005). Patients are typically over age 50 (likely reflecting NSAID use for degenerative joint disease), the onset is delayed a mean of 6 months from initiation of therapy compared to 2 weeks with (3-lactams (Perazella 2005). Also, there is a much lower incidence of fever, rash, and eosinophilia, and milder interstitial infiltration and eosinophilic infiltration are seen, which may be related to the anti-inflammatory properties of NSAlDs (Perazella 2005). 

AGEP acute generalized exanthematous pustulosis, DRESS drug reaction with eosinophilia and systemic symptoms, EM erythema multiforme, FDE fixed drug eruption, niAbs monoclonal antibodies, NMBDs neuromuscular blocking drugs, NSAIDs nonsteroidal anti-inflammatory drugs, SJS Stevens-Johnson syndrome, TEN toxic epidermal necrolysis... 

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