title: Nitrofurantoin-induced microangiopathic haemolytic anaemia and thrombocytopaenia in a patient with systemic lupus erythematosus.
abstract: Patients with systemic lupus erythematosus (SLE) may develop thrombotic thrombocytopaenic purpura (TTP) or TTP-like illness manifested by microangiopathic haemolytic anaemia (MAHA) and thrombocytopaenia. The distinction between active SLE and TTP is difficult because these entities share similar clinical features. Drug-induced TTP caused by an immune-mediated reaction have been documented for several drugs. Herein, we report a middle-aged Hispanic woman with long-standing SLE, who developed a TTP-like illness characterised by MAHA and thrombocytopaenia after exposure to nitrofurantoin. The patient responded well to plasmapheresis and immunosuppressive therapy and has remained clinically stable after 18&emsp14;months of follow-up. To our knowledge, this is the first case that reports the association between nitrofurantoin and a TTP-like presentation.
authors.affiliation: Department of Medicine, Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Linnette
authors.initials: L
authors.lastname: López-López
authors.forename: Noridza
authors.initials: N
authors.lastname: Rivera-Rodríguez
authors.forename: Luis M
authors.initials: LM
authors.lastname: Vilá
mesh_terms: D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects* / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000276:immunology; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009582:Nitrofurantoin / Q000009:adverse effects* / Q000627:therapeutic use*; D010949:Plasma; D010951:Plasma Exchange; D010956:Plasmapheresis; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000276:immunology
chemical_list: D000892:Anti-Infective Agents, Urinary; D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009582:Nitrofurantoin; D008775:Methylprednisolone