WITHDRAWN

Abstract

SESSION TITLE: Drug-Induced Lung Injury Pathology Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Nitrofurantoin is a common antibiotic prescribed for urinary tract infections. Acute pulmonary toxicity from nitrofurantoin can present in many ways that can be confused with a COPD exacerbation. This case gives us insight into a unique diagnosis of acute nitrofurantoin pulmonary toxicity on a patient who became immediately symptomatic after taking the medication. CASE PRESENTATION: An 80 y/o patient with COPD and DM presented to the hospital due to sudden onset shortness of breath. His symptoms began immediately after starting nitrofurantoin for an UTI. His symptoms were chest tightness, cough with sputum production, and body shakes. On admission, the patient was hemodynamically stable, but hypoxic requiring 10L NC to maintain an oxygen saturation of 90%. Laboratory evaluation demonstrated an elevated white count (12K/uL), eosinophils (5.6%), AST/ALT (209/380 U/L), and a lactic acid of 3.1 mmol/L. His sputum culture, coccidioidomycosis, viral panel, and blood cultures were negative. A CTA of his lungs showed emphysematous changes with bilateral ground glass opacities and no pulmonary embolism. Physical exam was relevant for end expiratory wheezing. The patient was started on bronchodilators and steroids for a COPD exacerbation on admission but failed to respond to treatment. Pulmonology was consulted for the persistent hypoxia. We found after chart review that the patient had prior admissions for COPD exacerbations that correlated with him starting nitrofurantoin as an outpatient. We decided to stop treating him for a COPD exacerbation, resume his home inhalers, and stop the nitrofurantoin. The patient was titrated off his oxygen within 24 hours and all his laboratory values were normalized. A follow up CT Chest showed resolution of the ground glass opacities. DISCUSSION: Nitrofurantoin toxicity is described in literature as hepatoxicity, pulmonary fibrosis, and rarer instances of acute pulmonary toxicity such as the case reported here (1). Our case highlights how nitrofurantoin toxicity can mimic a COPD exacerbation and if this diagnosis is not considered, patients have prolonged hospitalization or improper treatment. Most cases of pulmonary toxicity from nitrofurantoin usually respond well to stopping the antibiotic, like our patient (2). While nitrofurantoin has an excellent safety profile, it is important to be aware that there have been fatalities from pulmonary toxicity from nitrofurantoin (3). CONCLUSIONS: Pulmonary toxicity from nitrofurantoin can easily mimic a COPD exacerbation or a pneumonia. The symptoms from an acute toxicity usually occur within several hours to days of taking the antibiotic. When patients are admitted for acute hypoxia and infectious workup is negative, there needs to be a thorough review of medications and if nitrofurantoin is listed, it should be discontinued and listed to not be used again. Reference #1: Huttner A, Verhaegh EM, Harbarth S, Muller AE, Theuretzbacher U, Mouton JW. Nitrofurantoin revisited: a systematic review and meta-analysis of controlled trials. J Antimicrob Chemother. 2015 Sep;70(9):2456-64. doi: 10.1093/jac/dkv147. Epub 2015 Jun 11. PMID: 26066581. Reference #2: Khan TMA, Ansari Y, Siddiqui AH, Matthew H, Siddiqui F. Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin. Cureus. 2019;11(8):e5516. Published 2019 Aug 29. doi:10.7759/cureus.5516 Reference #3: Livanios K, Karampi ES, Sotiriou A, Tavernaraki K, Styliara P, Kainis E. Nitrofurantoin-induced acute pulmonary toxicity. Respirol Case Rep. 2016;4(1):25-27. Published 2016 Jan 14. doi:10.1002/rcr2.131 DISCLOSURES: No relevant relationships by Adnan Abbasi No relevant relationships by Bhargav Patel