Nitrofurantoin
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Pulmonary eosinophilia: case report A 46-year-old woman developed pulmonary eosinophilia while receiving nitrofurantoin for neurogenic bladder with frequent urinary tract infections. The woman, who had intermittently used nitrofurantoin for years [no details stated], presented with fatigue, mildly depressed mood, subjectively increased constipation and dysphagia; she also reported an almost 14-day history of a mild unproductive cough. She had restarted nitrofurantoin [dosage not stated] 14 days earlier. Chronic fatigue syndrome was suspected, but she then reported sparse white sputum production; a thoracic x-ray revealed peripheral lowtransparency areas in her left upper and middle lung fields, as well as a round peripheral mass in her left middle field. Spirometry determined a markedly restrictive ventilatory impairment. A contrast-enhanced CT scan revealed bilateral peripheral and left-dominant pulmonary infiltrates. Her total serum IgE was elevated at 210 IU/mL. Nitrofurantoin-induced pulmonary eosinophilia was diagnosed, despite the lack of blood eosinophilia. Nitrofurantoin was discontinued. The woman’s pulmonary consolidations were regressing 8 days later, and her dry cough and fatigue had almost completely resolved. Only few residual pulmonary consolidations persisted on x-ray after 4 weeks. Author comment: A preliminary diagnosis of pulmonary eosinophilia was made after exclusion of other causes. The clinical course, with regression of pulmonary changes and clinical improvement after nitrofurantoin discontinuation, confirmed the diagnosis. Schelhorn J, et al. Drug-induced eosinophilic pneumonia. Nervenarzt 79: 696-698, 801117092 No. 6, Jun 2008 [German] - Germany
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Reactions 19 Jul 2008 No. 1211
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