Abstract
Nitrofurantoin is a commonly prescribed urinary antiseptic both for acute treatment and prophylaxis against recurrent urinary tract infections. It is known for its safety, efficacy, tolerability and cost-effectiveness. Rarely, nitrofurantoin can cause acute and chronic lung and liver diseases. Acute pulmonary toxicity due to nitrofurantoin is more common than its chronic form and is probably a hypersensitivity reaction to the drug. In contrast, the chronic pulmonary toxicity appears to be due to cumulative drug exposure leading to chronic inflammation and fibrosis and is therefore an irreversible process. What predisposes to the rare and severe form of acute pulmonary toxicity is unknown. In this case, it appears that renal impairment may have played a role as a predisposing factor.
Highlights
The majority of patients affected with nitrofurantoin pulmonary toxicity are elderly women [1]
The patient died from progressive respiratory failure in two weeks from the date of hospitalization. It is unknown what exactly predisposes some patients to develop nitrofurantoin pulmonary toxicity and why the toxicity can be very serious in a small fraction of patients
There are published reports of acute and chronic concomitant pulmonary and hepatotoxicity; including a case of acute respiratory distress syndrome and hepatitis following a single dose of nitrofurantoin [9]
Summary
The majority of patients affected with nitrofurantoin pulmonary toxicity are elderly women [1]. Acute presentation is the most common form and is characterized by fever, rash, arthralgia, non-productive cough, chest pain, and dyspnea within days to weeks after the exposure. Sub-acute presentations have more insidious onset of symptoms, with most cases having received nitrofurantoin for several weeks to months. Chronic presentation and pulmonary fibrosis is typically seen in patients on nitrofurantoin therapy for several months or years with usual presenting symptoms of progressive dyspnea, fatigue and cough. We report an elderly female with subacute pulmonary symptoms after exposure to nitrofurantioin who succumbed to death from rapidly progressive respiratory failure. Imaging finding is non-specific in nitrofurantoin induced pulmonary toxicity. New onset of pulmonary symptoms, laboratory finding of eosinophilia along with history of drug exposure is highly suggestive of drug induced pulmonary toxicity. For severe form, it is probably reasonable to consider a therapeutic trial of steroid after ruling out infectious etiology or congestive heart failure
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