Nitrofurantoin
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Migratory arthralgia, pulmonary toxicity and hepatic toxicity: case report A 63-year-old woman developed migratory arthralgia, pulmonary toxicity and hepatic toxicity during treatment with nitrofurantoin as prophylaxis for urinary tract infections (UTI). The woman, who had a history of repetitive UTI, was referred to the rheumatology department for migratory asymmetrical arthralgias of 4-month onset. One year prior to the presentation of symptoms, she had started receiving UTI prophylaxis with nitrofurantoin [route and dosage not stated]. During examination dyspnoea with moderate effort was noted, which had appeared after the arthralgias. Auscultation showed bilateral crackling sounds. A chest X-ray revealed a bilateral interstitial pattern and high resolution CT scan revealed ground glass areas corresponding to acute/sub acute interstitial pneumonia. Blood tests highlighted AST 360 U/L, ALT 432 U/L and gamma-glutamyl transferase 279 U/L with normal abdominal ultrasound. Autoimmunity studies showed ANCA+1/640 perinuclear staining (negative anti-myeloperoxidase and anti-proteinase 3). Based on these findings systemic toxicity (arthralgia, pulmonary toxicity and hepatic toxicity) by nitrofurantoin was suspected. The woman’s nitrofurantoin therapy was stopped, and she was treated with prednisone, with a good response at respiratory level, a drop in hepatic enzymes and a complete resolution of arthralgias. During follow-up, the transaminase values remained normal, respiratory symptoms disappeared and posterior lung imaging tests showed normal results. The arthralgias abated and the ANCAs tested negative. Arevalo Ruales K, et al. Migratory arthralgia as the initial sign of systemic toxicity associated with chronic nitrofurantoin treatment. Reumatologia Clinica 16: 432-433, No. 5, 803516392 Sep-Oct 2020. Available from: URL: http://doi.org/10.1016/j.reuma.2018.07.006
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Reactions 21 Nov 2020 No. 1831
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