Bronchiolitis obliterans organising pneumonia associated with the use of nitrofurantoin

Abstract

The spectrum of nitrofurantoin lung injury continues to widen. The case histories are presented of two patients who developed lung disease associated with the use of nitrofurantoin with histological features of bronchiolitis obliterans organising pneumonia (BOOP), a rare but recognised form of drug induced injury. The two middle aged women presented with respiratory symptoms after prolonged treatment with nitrofurantoin. Both had impaired lung function and abnormal computed tomographic scans, and their condition improved when nitrofurantoin was withdrawn and corticosteroid treatment commenced. The favourable outcome in these two patients contrasts with the fatal outcome of the two other reported cases of nitrofurantoin induced BOOP. We suggest that the previous classification of nitrofurantoin induced lung injury into "acute" and "chronic" injury is an oversimplification in view of the wide variety of pathological entities that have subsequently emerged.

Pneumonia eosinofílica crônica secundária ao uso prolongado de nitrofurantoína: achados da tomografia computadorizada de alta resolução do tórax

“…The principal chronic alterations associated with nitrofurantoin are usually found in the lung bases, (3,16,17) although sparse peribronchovascular alterations have been described in patients presenting BOOP as a reaction to nitrofurantoin administration. (5) There can be an overlap between the clinical, radiological, and pathological findings of chronic eosinophilic pneumonia and those of BOOP. However, in many cases, HRCT helps to differentiate between these two diseases.…”

“…(1) Since then, there have been various reports of nitrofurantoin-induced pulmonary reactions, with polymorphic profiles that include pulmonary fibrosis, (2,3) alveolar hemorrhage, (4) bronchiolitis obliterans organizing pneumonia (BOOP), (5) lupus-like syndrome, (6) desquamative, usual, and nonspecific interstitial pneumonias, (7) allergic reactions, (8) diffuse alveolar damage, (9) and eosinophilic pneumonia. (10) Nitrofurantoin-induced pulmonary disease has two principal forms of presentation: the acute form, which is more common, develops hours to days after the use of the medication, and is probably related to a hypersensitivity reaction or to an immunologcosteroid therapy previously performed in another facility was unsuccessful, and an open-lung biopsy was then performed, resulting in a histopathological diagnosis of diffuse interstitial fibrosis.…”

Nitrofurantoin-Induced Pulmonary Reaction Involving Respiratory Symptoms: Case Report

“…7 In most cases, administration of prednisone 30 to 40 mg daily for 5 weeks to 16 months has been associated with positive outcomes: either complete resolution or partial recovery in terms of clinical symptoms and radiographic imaging. 6,8,9,12 In 2 cases, corticosteroid therapy was ineffective, and the patients died from infectious complications. Both of these patients were ex-smokers, and the corticosteroid was tapered rapidly after initial recovery.…”

“…1,[6][7][8][9] According to available case reports, nitrofurantoin-induced BOOP is associated with long-term therapy ranging from 6 months to 4 years and is often characterized by delayed onset of symptoms. [6][7][8][9]12 In the case reported here, the score of 5 on the Naranjo Adverse Drug Reaction Probability Scale 13 indicated that the patient's BOOP was probably related to the use of nitrofurantoin. The patient had a 6-day history of nonproductive cough and dyspnea before presenting to the hospital with hypoxia and had received a total of 11 days of nitrofurantoin therapy at the time of presentation.…”

Nitrofurantoin-induced lung disease and prophylaxis of urinary tract infections

“…Resolution of chronic PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org Table 1. Pulmonary manifestations of nitrofurantoininduced lung disease [11][12][13][14][15][16] NILD can take from several months to a year. 5,12 Prognosis depends on early recognition and cessation of the drug.…”