Reversible interstitial lung disease with prolonged use of nitrofurantoin: Do the benefits outweigh the risks?

Abstract

We describe the case summary of a 70-year-old man diagnosed with interstitial lung disease due to prolonged nitrofurantoin therapy. Despite honeycombing confirmed by computed tomography of the thorax, symptoms and radiographic findings disappeared within 1 month after withdrawal of nitrofurantoin. The case highlights the fact that nitrofurantoin-induced lung disease may run a benign course and respond favorably despite radiographic evidence of established lung fibrosis (honey combing).

Acute pulmonary function decline and radiographic abnormalities: chronic cause?

“…NSIP is the most commonly reported pattern in association with nitrofurantoin [ 2 , 3 ]. Imaging features indicative of UIP [ 4 – 6 ], DAD and organising pneumonia [ 7 ] have all been reported with nitrofurantoin use. HP is also commonly reported [ 8 ] and there have been rare cases of chronic eosinophilic pneumonia [ 9 ] and giant cell interstitial pneumonia [ 10 , 11 ].…”

Adverse Drug Reactions in the ICU

“…Nitrofurantoin is associated with acute or subacute pneumonitis (ILD) characterized generally with bilateral and symmetric pulmonary opacities. Pulmonary fibrosis, eosinophilic pneumonia, or pleuropathy (discussed later) may be present with restrictive lung dysfunction and hypoxemia, which usually resolve after the drug is discontinued [172][173][174].…”