The authors report a case of tubulo-interstitial nephritis with acute
renal failure due to vancomycin used to treat a patient with enterococ
cus endocarditis. Rechallenge with vancomycin several days after stopp
ing the drug resulted in the appearance of a maculopapular rash and ra
pid onset of acute oligo-anuric renal failure. Renal biopsy revealed a
cute interstitial nephritis. This feature is suggestive of cellular me
diated hypersensitivity.