Nitrofurantoin-induced immune-mediated lung and liver disease

A 60-year-old woman with multiple sclerosis and recurrent urinary tract inf ections (UTI) was evaluated for the recent onset of a dry cough, dyspnea on exertion, and jaundice. Investigation demonstrated interstitial lung disea se with bilateral infiltrates and unilateral effusion, as well as a severe chronic active hepatitis with marked fibrosis, Other notable features were positive antinuclear antibodies and anti-smooth-muscle antibodies and the a bsence of any possible cause except for nitrofurantoin treatment (Macrodant in, 100 mg/day), which the patient had been taking for the previous 3 years as a prophylactic measure against UTI, The patient died of pneumococcal se pticemia less than 30 days after presentation. Pulmonary or hepatic injury caused by nitrofurantoin treatment is rare; their combined occurrence is ha rdly ever described, Combined drug-induced pulmonary and hepatic toxicity i s reviewed and should be considered early in the differential diagnosis to allow reversibility and avoid serious outcomes.