A 28-year-old woman on oral contraceptives presents 3 days after starting trimethoprim-sulfamethoxazole for a urinary tract infection. She has fever (38.5°C), BP 128/82 mmHg, HR 102/min, and a diffuse maculopapular rash. Laboratory studies reveal serum creatinine 2.8 mg/dL (baseline 0.9), sterile pyuria, and 8% eosinophiluria. Urinalysis shows no bacterial growth. Which of the following is the most likely diagnosis?
- A)Acute glomerulonephritis
- B)Acute pyelonephritis with sepsis
- C)Acute interstitial nephritisGABARITO
- D)Thrombotic thrombocytopenic purpura
- E)Drug-induced systemic lupus erythematosus
Explicação
Classic AIN triad: fever, rash, AKI. TMP-SMX is a common AIN culprit (beta-lactams and NSAIDs are most common overall). The timing (3 days post-exposure), sterile pyuria, and eosinophiluria (WBCs in urine with eosinophil predominance) are pathognomonic. Eosino... Ver explicação completa e trilha adaptativa →