Nitrofurantoin-induced pulmonary toxicity: A case report and review of the literature

Abstract

This paper describes a case of lung injury attributed to the use of Nitrofurantoin and a review of the relevant literature. An 88-year-old woman was admitted to the floor for the evaluation of recent symptoms of dyspnea, fatigue and productive cough. She was initiated on nitrofurantoin 300 mg per day for the treatment of a urinary tract infection 3 days earlier. Upon examination, chest auscultation revealed bilateral inspiratory crackles. Chest radiograph showed bilateral airspace and interstitial infiltrates. Laboratory studies revealed an elevated white blood cell count of 13,500/μL (reference range = 5200-12,400/μL) and blood eosinophilia (10%, reference range: 0-7%). Using clinical judgment and the algorithm of Naranjo, it was determined that nitrofurantoin use was the probable cause of the patient's lung injury. Symptomatic improvement was observed shortly after the drug was discontinued. A review of information from several European and North American pharmacovigilance databases (through June 2014) identified several reports of suspected nitrofurantoin-induced toxicity, including reports of acute toxicity reactions, which were related in many ways to the case we are reporting here.

The value of time‐to‐onset in statistical signal detection of adverse drug reactions: a comparison with disproportionality analysis in spontaneous reports from the Netherlands

“…Because sensitivity was in general low for the TTO method, empirical cumulative distribution (ECD) plots were made for the TTO of several drug – ADR associations to provide a visual insight into the TTO distributions. For illustrative purposes, one TP signal (nitrofurantoin – interstitial lung disease) and one false negative signal (simvastatin – myopathy) were selected based on the well‐known causal relationship of both associations …”

“…For illustrative purposes, one TP signal (nitrofurantoininterstitial lung disease) and one false negative signal (simvastatinmyopathy) were selected based on the well-known causal relationship of both associations. 19,20…”

Unusual effects of common antibiotics

“…While more widely recognized, nitrofurantoin pulmonary toxicity Daptomycin should be stopped early for acute eosinophilic pneumonia, as it can be deadly is rare, occurring in 1 in 5,000 patients. 30…”

Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin

“…Nitrofurantoin is used to treat uncomplicated urinary tract infection, and its use can lead to acute, subacute, or chronic pulmonary toxicity [1]. Nitrofurantoin-associated pulmonary toxicity can manifest as cough, mild fever, shortness of breath, and pulmonary infiltrates on clinical imaging [2][3][4][5][6][7]. We report a hyperacute presentation of nitrofurantoin-induced toxicity initiated within two days of nitrofurantoin use manifesting as a severe systemic inflammatory response with fever, shaking, chills, lethargy, leukocytosis, significantly elevated C-reactive protein (CRP) and procalcitonin (PCL) levels mimicking severe sepsis of bacterial origin though no infective cause for these symptoms was found.…”