Autoimmune hepatitis triggered by nitrofurantoin: a case series.
BACKGROUND
Drugs can occasionally trigger the onset of autoimmune liver disease.


METHODS
Three Caucasian women (aged 65, 42 and 74 years old) who were receiving long-term nitrofurantoin as prophylaxis against recurrent urinary tract infections developed hepatitic liver disease. Serological auto-antibody profiles and liver histology appearances were consistent with autoimmune hepatitis. Two of the patients presented with jaundice, and one required a prolonged hospital admission for liver failure. In all three patients nitrofurantoin was withdrawn, and long-term immunosuppressive therapy with prednisolone and azathioprine or mycophenolate was given. The patients responded well, with liver biochemistry returning to normal within a few months.


CONCLUSIONS
Although nitrofurantoin rarely causes autoimmune hepatitis, this antimicrobial is increasingly used as long-term prophylaxis against recurrent urinary tract infection. General practitioners and urologists who prescribe long-term nitrofurantoin therapy should be aware of this adverse effect.
Appleyard
Sally
S
Wycombe Hospital, Queen Alexandra Road, High Wycombe, Bucks HP11 2TT, UK. david.gorard@buckshosp.nhs.uk.
Saraswati
Ruma
R
Gorard
David A
DA