title: [Autoimmune hepatitis triggered by nitrofurantoin: A rare drug-induced toxicity].
abstract: BACKGROUND
  Nitrofurantoin is a commonly used drug which can have liver and pulmonary adverse effects. Among hepatic nitrofurantoin-induced adverse effects, autoimmune hepatitis is a rare complication which must not be mistaken as a toxic hepatitis.
  
  
  METHODS
  We report an 86-year-old woman who presented with acute hepatitis after a 3-month course of nitrofurantoin administration for urinary tract infections. She reported a previous hepatitis after treatment by nitrofurantoin twenty years before. Biological analysis showed polyclonal hypergammaglobulinemia, positive test for antinuclear antibodies and smooth muscle antibodies. Finally, liver histology showed lymphocytic infiltration, marked necrotic and inflammatory activity consistent with the diagnosis of autoimmune hepatitis. Nitrofurantoin was discontinued. Outcome of autoimmune hepatitis was good with corticosteroids and azathioprine but two months later, the patient died from a refractory global heart failure.
  
  
  CONCLUSIONS
  Nitrofurantoin-induced autoimmune hepatitis is a severe condition which must be systematically discussed in patients taking nitrofurantoin who present with acute hepatitis. Hypergammaglobulinemia is an easily obtained blood marker, which can suggest this diagnosis. Treatment relies on nitrofurantoin eviction, corticosteroids and sometimes azathioprine. Outcome is usually favorable.
authors.affiliation: Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: B
authors.initials: B
authors.lastname: Sorin
authors.affiliation: Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: M
authors.initials: M
authors.lastname: Pineton de Chambrun
authors.affiliation: Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; UPMC, université Paris VI, sorbonnes université, 75013 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Haroche
authors.affiliation: UPMC, université Paris VI, sorbonnes université, 75013 Paris, France; Service d'accueil des urgences, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Freund
authors.affiliation: UPMC, université Paris VI, sorbonnes université, 75013 Paris, France; Département d'immunochimie, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Miyara
authors.affiliation: Service d'anatomo-pathologie, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Charlotte
authors.affiliation: Centre régional de pharmacovigilance, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Lebrun-Vignes
authors.affiliation: Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; UPMC, université Paris VI, sorbonnes université, 75013 Paris, France.
authors.forename: Z
authors.initials: Z
authors.lastname: Amoura
authors.affiliation: Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; UPMC, université Paris VI, sorbonnes université, 75013 Paris, France. Electronic address: fleur.cohen@aphp.fr.
authors.forename: F
authors.initials: F
authors.lastname: Cohen Aubart
mesh_terms: D000369:Aged, 80 and over; D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000209:etiology*; D006801:Humans; D009582:Nitrofurantoin / Q000009:adverse effects*
chemical_list: D000892:Anti-Infective Agents, Urinary; D009582:Nitrofurantoin
keywords: Autoimmune hepatitis; Drug-induced toxicity; Hépatite auto-immune; Iatrogénie; Nitrofurantoin; Nitrofurantoïne