Severe Alopecia, Dermatitis and Acute Interstitial Nephritis Following Oral Semaglutide (Rybelsus) That Is Amenable to Drug-Discontinuation and 6-Weeks of Prednisone<br>—Rybelsus Interstitial Nephritis

Background: Oral Semaglutide with the brand name Rybelsus (R) is the first long-acting oral glucagon-like peptide 1 receptor agonist approved by the U.S. Food and Drug Administration for treatment of obesity and hence type 2 diabetes in 2019. It is associated with short-term side effects (SEs) viz. gastrointestinal upsets, anaphylaxis, angioedema and drug-interaction as well as long-term ones viz. gastroparesis, retinal disease, gall stones and suicidal ideation. The reported spectrum of its renal SEs was thought to be limited to volume depletion following gastrointestinal upsets. In this case report; we add an intrinsic etiology to its renal SEs. The Case: A 56-year-old man developed malaise, diffuse myalgia, skin rash and alopecia for 1 month following intake of R for weight reduction. He did not have a previous medical illness or chronic intake of other medications. Moreover; he had acute and progressive renal failure. His kidney biopsy showed acute interstitial nephritis. Serum complements, ANA, ANCA, protein electrophoresis, IgG4 level, and hepatitis B and C serology were within normal levels. R was discontinued and the patient was treated with Prednisone 60 mg/day. By 2 weeks later; his clinical picture and renal function returned to normal. Hence; the Prednisone dose was tapered down gradually and discontinued by the end of 6 weeks. Over the past year, no disease recurrence was observed. Conclusion: Acute allergic reactions associated with interstitial nephritis can develop, in genetically predisposed patients, following R-use yet they are amenable to drug-discontinuation and 6-week therapy with Prednisone.