Bronchiolitis obliterans organising pneumonia associated with the use of nitrofurantoin

The spectrum of nitrofurantoin lung injury continues to widen. The case his tories are presented of two patients who developed lung disease associated with the use of nitrofurantoin with histological features of bronchiolitis obliterans organising pneumonia (BOOP), a rare but recognised form of drug induced injury. The two middle aged women presented with respiratory sympto ms after prolonged treatment with nitrofurantoin. Both had impaired lung fu nction and abnormal computed tomographic scans, and their condition improve d when nitrofurantoin was withdrawn and corticosteroid treatment commenced. The favourable outcome in these two patients contrasts with the fatal outc ome of the two other reported cases of nitrofurantoin induced BOOB We sugge st that the previous classification of nitrofurantoin induced lung injury i nto "acute" and "chronic" injury is an oversimplification in view of the wi de variety of pathological entities that have subsequently emerged.