Nitrofurantoin-induced pulmonary fibrosis: a case report

Abstract

IntroductionNitrofurantoin is a commonly used drug in the treatment and prevention of urinary tract infections. Many adverse effects of nitrofurantoin have been documented, including aplastic anemia, polyneuritis, and liver and pulmonary toxicity.Case presentationWe describe the clinical history and the autopsy findings in a 51-year-old woman with lung fibrosis of unknown etiology. She had a history of recurrent urinary tract infections, treated with nitrofurantoin for many years. She was referred to our hospital for screening for lung transplantation because of severe pulmonary restriction and dyspnea. Unfortunately, she died as a result of progressive respiratory insufficiency. At autopsy bilateral patchy, sharply circumscribed fibrotic areas in the upper and lower lobes of the lungs were seen with honeycombing. Microscopically, end-stage interstitial fibrosis with diffuse alveolar damage was observed. Due to the atypical distribution of the fibrosis involving both the lower and upper lobes of the lung, the microscopic pattern of the fibrosis and the history of long-term nitrofurantoin use, we concluded that this drug induced the lung fibrosis. The recurrent urinary tract infections were probably caused by a diverticulum of the urinary bladder, which was discovered at autopsy.ConclusionThis case shows that the use of nitrofurantoin may cause severe pulmonary disease. Patients with long-term use of nitrofurantoin should be monitored regularly for adverse pulmonary effects.

Nitrofurantoin-Induced Pulmonary Reaction Involving Respiratory Symptoms: Case Report

“…Several mechanisms have been proposed, and hypersensitivity to nitrofurantoin is the most probable cause. 17 Pulmonary injury secondary to hypersensitivity reactions is not dose-related. Lymphocytes are activated by nitrofurantoin to produce mediators that promote the release of cytokines, resulting in lymphocytic alveolitis.…”

Nitrofurantoin-induced lung disease and prophylaxis of urinary tract infections

“…11 HRCT scan findings are varied and include ground-glass attenuation, honeycombing, inter-and intralobular septal thickening, traction bronchiectasis and organising pneumonia. [11][12][13] There are many different forms of pulmonary involvement in NILD (see Table 1). …”

“…Evidence for the use of corticosteroids is lacking and largely supported by anecdotal case reports. 12,13 Most centres do not use steroids unless there is severe systemic illness and infection has been excluded as the cause of the symptoms.…”

“…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.…”

Pulmonary Fibrosis Due to Nitrofurantoin Therapy: A Case Report

“…The high prevalence of multi-drug resistant organisms has negatively impacted the microbial epidemiology of prostatitis and thus has limited oral treatment options. Frequently, nowadays the therapeutic approach mandates prolonged parenteral courses that unfortunately are frequently associated with high relapse rates [1] [2]. Nitrofurantoin is one of the drugs used to prevent urinary tract infections (UTIs) but it is also known to be associated with adverse pulmonary reactions [3] [4] [5] [6] [7].…”