Lung toxicity and Nitrofurantoin: the tip of the iceberg?

Abstract

A 56-year-old female was referred to the respiratory clinic by her general practitioner with a 3-month history of dyspnoea and cough. She was a non-smoker. Her cough persisted despite several trials of medication, including antibiotics and inhaled bronchodilator and steroid therapy. Her past medical history included cervical cancer in 1997 with vault relapse in 1999, treated by hysterectomy, chemotherapy and radiotherapy; breast cancer in 2001 treated with wide local excision, chemotherapy and radiotherapy subsequently troubled with leg and arm lymph oedema. Following her gynaecological illnesses, she had been troubled with recurrent urinary tract infections and for the last 12 months she had been treated with prophylactic Nitrofurantoin. On examination, she was tachypnoeic at rest. Room air saturations were 88%, falling to 76% on minimal exertion. Chest auscultation revealed bilateral inspiratory crackles. Spirometry showed an FEV1 1.38 (59%), FVC …