Nitrofurantoin-induced immune-mediated lung and liver disease.
A 60-year-old woman with multiple sclerosis and recurrent urinary tract infections (UTI) was evaluated for the recent onset of a dry cough, dyspnea on exertion, and jaundice. Investigation demonstrated interstitial lung disease with bilateral infiltrates and unilateral effusion, as well as a severe chronic active hepatitis with marked fibrosis. Other notable features were positive antinuclear antibodies and anti-smooth-muscle antibodies and the absence of any possible cause except for nitrofurantoin treatment (Macrodantin, 100 mg/day), which the patient had been taking for the previous 3 years as a prophylactic measure against UTI. The patient died of pneumococcal septicemia less than 30 days after presentation. Pulmonary or hepatic injury caused by nitrofurantoin treatment is rare; their combined occurrence is hardly ever described. Combined drug-induced pulmonary and hepatic toxicity is reviewed and should be considered early in the differential diagnosis to allow reversibility and avoid serious outcomes.
Schattner
A
A
Department of Medicine, Kaplan Medical Center, Rehovot, Israel.
Von der Walde
J
J
Kozak
N
N
Sokolovskaya
N
N
Knobler
H
H
D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000276:immunology*; D008171:Lung Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology*; D008875:Middle Aged; D009582:Nitrofurantoin / Q000009:adverse effects*
D000892:Anti-Infective Agents, Urinary; D009582:Nitrofurantoin