The Impact of Ibuprofen on Acute Kidney Injury in Brucellosis: A Case Report

By Klejda ÇOLLAKU, Neada HOXHA, Armanda SARACI, Olta ZENELI

Abstract
Purpose: To report a case of acute kidney injury (AKI) in a patient with brucellosis, highlighting the role of nephrotoxic medications, particularly ibuprofen, in its development. Brucellosis is a systemic zoonotic infection with diverse clinical manifestations, while renal involvement remains an uncommon but recognized complication [1–3,6].
Methodology: A 65-year-old male with poorly controlled type 2 diabetes mellitus presented with fever, anemia, hepatosplenomegaly, and bilateral pleural and pericardial effusions, consistent with severe systemic brucellosis [1,3]. Serological testing confirmed the diagnosis (Wright agglutination test 1:320, positive). The patient was treated with rifampicin and doxycycline, in accordance with recommended therapy for brucellosis [2,5], along with supportive medications including ibuprofen, spironolactone, and furosemide. Clinical course, laboratory findings, and therapeutic adjustments were carefully reviewed.
Findings: After two weeks of therapy, the patient developed AKI (urea 159 mg/dL, creatinine 3.2 mg/dL, potassium 5.5 mmol/L) with preserved urine output.
Nephrotoxic agents, including NSAIDs and spironolactone, were discontinued, while anti-brucellosis therapy was maintained. Supportive management, including hydration and electrolyte correction, resulted in complete renal recovery within two weeks (urea 54 mg/dL, creatinine 1.22 mg/dL, potassium 4.5 mmol/L). No recurrence of effusions or hepatosplenomegaly was observed. These findings are consistent with previously reported cases of reversible renal involvement in brucellosis [4,6].
Conclusion: Acute kidney injury in brucellosis is rare but possible [3,6]. Its development may be influenced by a combination of infectious factors, drug-induced nephrotoxicity, and patient-related risk factors such as diabetes and hypertension, which can increase renal vulnerability [4,6]. Early recognition of AKI is essential for favorable outcomes. Careful monitoring of renal function and cautious use of potentially nephrotoxic agents, including NSAIDs or aminoglycosides, can help prevent permanent kidney damage.
Originality: This case highlights the rarely reported contribution of ibuprofen to AKI in the setting of brucellosis, underscoring the need for vigilance when prescribing potentially nephrotoxic medications in infected patients