Acute Interstitial Nephritis Secondary to Traditional Bark-Based Therapy - Boswellia serrata : A Case Report

Traditional herbal remedies are widely used in India, but their nephrotoxic potential is often under-recognized. We describe a 41-year-old man who developed fever, nausea, vomiting, and acute kidney injury within hours of ingesting Boswellia serrata bark powder. Kidney biopsy demonstrated dense interstitial inflammation with lymphocytes, plasma cells, and eosinophils, consistent with acute interstitial nephritis. Fourier-transform infrared spectroscopy (FTIR) analysis identified calcium oxalates and calcium apatite in the bark powder. The patient required two sessions of hemodialysis and high-dose steroids, achieving complete recovery in 3 weeks. This is the first documented case of biopsy-proven acute interstitial nephritis linked to Boswellia serrata bark powder, and highlights the need for caution with unprocessed herbal preparations.