Nitrofurantoin
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Lung toxicity: case report A 60-year-old woman developed lung toxicity during treatment with nitrofurantoin. The woman started receiving treatment with nitrofurantoin 100mg daily on 26 October 2013 [route not stated]. However, on 1 May 2014, it was discontinued due to productive cough. A chest x-ray showed patchy bilateral infiltrates and subsequent CT scan revealed bilateral opacities. Based on these findings the pneumonia was suspected. She had not responded to a brief trial of outpatient unspecified antibiotics and steroids. Therefore, bronchoscopy was performed which was unremarkable for any lesions bilaterally. Additionally, during the procedure no densities or masses were identified. In addition to cytology brushing, she had aspiration by bronchoalveolar lavage, and several trans-bronchial biopsies of the right upper lung. Surgical pathology examination showed atypical pneumonic cystic hyperplasia with a cluster of cells suspicious for neoplasm on initial evaluation. Due to the suspicion of a primary small cell lung carcinoma, the pathologist investigated more specifically if there was a lung mass on imaging. After further investigation, a final path report excluded carcinoma from the diagnosis despite the fact that initial review of the samples showed cells resembling oat cells. Based on further pathology investigation and laboratory findings the correct diagnosis of lung toxicity associated with nitrofurantoin use was made [time to reaction onset not stated]. The woman was treated with prednisone, and her condition clinically improved. During last follow up, it was reported that she had no residual pulmonary symptoms or findings. Miskoff J, et al. Nitrofurantoin toxicity: A near case of mistaken identity. American Journal of Respiratory and Critical Care Medicine 199: (plus poster) abstr. A1517, No. 9, 803446064 May 2019. Available from: URL: https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A1517 [abstract]
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Reactions 18 Jan 2020 No. 1787
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