- classically presents with fever, rash, peripheral eosinophilia and oliguric renal failure after 7 - 10 days treatment with methicillin or another B-lactam antibiotics
- atypical reactions can occur with NSAIDs in which fever, rash and eosinophilia are rare but acute renal failure with heavy proteinuria is common
- urinalysis reveal pyuria with white blood cell casts and hematuria
- renal biopsy usually not required for diagnosis but reveals extensive interstitial and tubular infiltration of leukocytes, including eosinophils
- discontinuation of offending agent often leads to reversal of renal injury
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