Nitrofurantoin-induced hepatotoxicity mediated by CD8+ T cells.
Nitrofurantoin is a synthetic nitrofuran commonly used for the treatment and prophylaxis of urinary tract infections. We describe the case of a 75-yr-old woman who was taking nitrofurantoin as prophylaxis against recurrent urinary tract infections, and who subsequently developed pulmonary and hepatic toxicity. We postulate that a breakdown product of the drug or the drug itself complexed to an endogenous peptide is presented by the class I HLA antigen on the hepatocyte cell membrane, inducing cytotoxic T cell activation and subsequently, hepatocyte death.
Kelly
B D
BD
Department of Gastroenterology, University College Hospital, Galway, Ireland.
Heneghan
M A
MA
Bennani
F
F
Connolly
C E
CE
O'Gorman
T A
TA
D000368:Aged; D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008099:Liver / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D008168:Lung / Q000187:drug effects; D008213:Lymphocyte Activation; D009582:Nitrofurantoin / Q000009:adverse effects*; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology* / Q000473:pathology
D000892:Anti-Infective Agents, Urinary; D009582:Nitrofurantoin