[Topical silver sulfadiazine-induced acute renal failure].

Abstract

INTRODUCTION:

Prolonged topical application of silver sulfadiazine cream can induce argyria and adverse effects of sulphonamides. We report a case of a woman with acute renal failure following repeated applications of topical silver sulfadiazine on pyoderma gangrenosum wounds.

CASE REPORT:

A 61 year-old woman suffering from rheumatoid arthritis, Sjogren's syndrome and scleroderma was treated with corticosteroids (1 mg/kg/day) and topical application of silver sulfadiazine cream (200 g/day) for extensive pyoderma gangrenosum wounds on the legs. Three weeks later, the patient was transferred to intensive care because of pulmonary edema, oligoanuria and disrupted consciousness. Laboratory data revealed leukopenia (1100/mm(3)) with neutropenia and renal failure (serum creatinine 316 micromol/l). Proteinuria was moderate and ultrasonography of the kidneys was normal. Silver concentration in blood was 1818 nmol/l (N < 92 nmol/l) and 1381 nmol/l (N < 9 nmol/l) in urine. Sulfadiazine concentration in blood was undetectable. All the signs regressed after withdrawal of silver sulfadiazine and after several sessions of hemodialysis.

DISCUSSION:

Various causes of renal failure are discussed in our patient. However, direct silver-induced renal toxicity is the most likely and is confirmed by the high concentration of silver in blood and urine and the improvement on withdrawal of the topical cream, without modification in the oral treatment. The absence of red corpuscles and crystals in the urine and undetectable concentrations of sulfadiazine in blood are not in favor of sulphonamide renal toxicity. Furthermore, the autoimmune diseases of our patient were well-controlled. Leukopenia could be secondary to silver sulfadiazine medullar toxicity. This observation confirms that this topical cream should not be used for long periods on extensive wounds.

• Authors: G Chaby, V Viseux, J-F Poulain, B De Cagny, J-P Denoeux, C Lok
• Journal: Annales de dermatologie et de venereologie (Ann Dermatol Venereol) Vol. 132 Issue 11 Pt 1 Pg. 891-3 (Nov 2005) ISSN: 0151-9638 [Print] France
• Vernacular Title: Insuffisance rénale aiguë après application topique de sulfadiazine argentique.
• PMID: 16327720 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Anti-Infective Agents, Local
• Silver Sulfadiazine

Topics

• Acute Kidney Injury (chemically induced)
• Administration, Topical
• Anti-Infective Agents, Local (administration & dosage, adverse effects, therapeutic use)
• Arthritis, Rheumatoid (drug therapy)
• Female
• Humans
• Middle Aged
• Neutropenia (chemically induced)
• Scleroderma, Localized (drug therapy)
• Silver Sulfadiazine (administration & dosage, adverse effects, therapeutic use)
• Sjogren's Syndrome (drug therapy)