Nitrofurantoin
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Peripheral nerve toxicity: 2 case reports Two patients developed peripheral nerve toxicity during treatment with nitrofurantoin. A 59-year-old woman, who had undergone a repair for prolapsed bladder, received prophylactic nitrofurantoin 100 mg/day [route not stated] for urinary retention. Four weeks later, she reported generalised dysaesthesias involving her neck, shoulders and thighs. She also developed photosensitivity and generalised livedo reticularis involving her face and extremities. Nitrofurantoin was discontinued; however, her symptoms persisted. Autoimmune and connective tissue serology investigations were unremarkable. She received prednisolone acetate which relieved her symptoms, but tapering resulted in symptom recurrence. She also received antihistamines and leukotriene receptor antagonists, which were ineffective. She had fatigue and weight loss; skin biopsy showed normal intraepidermal nerve fibre density (INFD) with morphologic changes of clustered swellings of terminal nerve fibres. She experienced partial relief from her symptoms with gabapentin and duloxetine treatment, although she remained symptomatic at 3 years follow-up. A 53-year-old woman with a urinary tract infection (UTI) received nitrofurantoin [dosage and route not stated] for 1 week. She developed burning pelvic pain after treatment, which was thought to be due to recurrent UTIs; she received multiple courses of antibiotics which were ineffective. Laparoscopic investigation found no cause of her pain, and her symptoms subsequently spread to involve her hands, feet, thighs, perineum and shoulders. She also had arthralgia, headache, malaise and weight loss. CSF analysis showed a glucose level of 55 mg/dL, a protein level of 67 mg/dL and a WBC count of 1/µL. Skin biopsy showed normal INFD with clustered terminal nerve fibre swellings. She was treated with duloxetine and fentanyl with subsequent improvement in her symptoms; however, her skin biopsy abnormalities persisted at 6 months followup. Tan IL, et al. Peripheral nerve toxic effects of nitrofurantoin. Archives of Neurology 69: 265-268, No. 2, Feb 2012. Available from: URL: http:// dx.doi.org/10.1001/archneurol.2011.1120 - USA
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Reactions 5 May 2012 No. 1400
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