Introduction: Tubulointerstitial nephritis (TIN) is a histological diagnosis that can manifest with the classic triad: fever, rash, and eosinophilia. Among the leading causes is consuming non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase 2 (COX2) inhibitors. We present an unusual case of TIN development with topical NSAID exposure in an adolescent. Clinical case: 16-year-old woman admitted for the study of acute abdomen with repeated emetic episodes. During hospitalization, he developed non-oliguric acute renal failure, hyperphosphatemia, proteinuria, metabolic acidosis, hyperuricemia, hyperparathyroidism, decreased vitamin D, and developed arterial hypertension. Evolution: The patient required vitamin D, antihypertensives, allopurinol, and parenteral hydration. She did not require hemodialysis or steroids. Progressively, the patient improved and was discharged. The renal biopsy report was confirmed in the outpatient clinic as acute patchy tubulointerstitial nephritis. Conclusion: It is essential to know that all NSAIDs have the potential risk of generating tubulointerstitial nephritis. This rule-out diagnosis should not be underestimated in clinical practice, even with topical NSAID treatment.