END-STAGE LIVER-DISEASE ASSOCIATED WITH NITROFURANTOIN REQUIRING LIVER-TRANSPLANTATION

OBJECTIVE: To report the apparent development of endstage liver diseas e secondary to nitrofurantoin administration. PATIENT: A 40-year-old w oman developed hepatic failure after receiving nitrofurantoin 200 mg p o bid for one month for prophylaxis against urinary-tract infections. Symptoms first occurred after two weeks of nitrofurantoin therapy. Oth er causes of hepatic failure (e.g., viral infection, autoimmune disord er, concomitant medications, cancer, wilson's disease, ethanol abuse, pregnancy) were ruled out. CONCLUSIONS: Acute and chronic hepatic inju ry has previously been reported with the use of nitrofurantoin. The pr oposed mechanism may be immunoallergic or metabolic in origin. On eval uating concomitant diseases and medications in our patient as well as the temporal sequence of her signs and symptoms, it appears that she d eveloped hepatic failure secondary to the use of nitrofurantoin, ultim ately necessitating orthotopic liver transplantation. The potential fo r the development of such a severe adverse reaction warrants careful e valuation of symptoms that may potentially be caused by hepatic damage as well as immediate discontinuation nitrofurantoin in patients prese nting with jaundice.