Reversible lung fibrosis in a 6-year-old girl after long term nitrofurantoin treatment

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CASE REPORT

Reversible lung fibrosis in a 6‑year‑old girl after long term nitrofurantoin treatment Lise Fischer Mikkelsen*  and Sune Rubak

Abstract  Background:  Pulmonary side effects are well known, including lung fibrosis, in elderly patients treated with longterm nitrofurantoin to prevent urinary tract infections and secondary renal injury. However, pulmonary side effects have only been reported rarely in paediatric cases, despite nitrofurantoin being a first line prophylactic treatment of recurrent childhood urinary tract infection. Case presentations:  A 6-year-old girl was admitted to the hospital with dyspnea, general fatigue, loss of appetite and need for nasal oxygen treatment after long-term nitrofurantoin treatment. A computed tomography scan of the chest showed lung fibrosis. A biopsy confirmed this diagnosis. We suspected the fibrosis to be caused by the nitrofurantoin treatment. Thorough examinations reveal no other explanations. Nitrofurantoin was discontinued and the girl was treated with methylprednisolone. After 17 month a new scan and lung function test showed total regression of the lung fibrosis. Conclusions:  This case underlines that risk of severe side effects should be taken in to account before initiation of long-term nitrofurantoin treatment in children. Keywords:  Nitrofurantoin, Side effects, Urinary tract infection, Lung fibrosis, Paediatrics Background Nitrofurantoin has been a first line antibiotic choice in prophylactic treatment of childhood urinary tract infection. Pulmonary toxicity causing irreversible pulmonary fibrosis is a well-known side effect of long-term nitrofurantoin treatment and other biological treatments in adults and elderly [1-4]. However, only few cases have been reported of pulmonary affection in children after nitrofurantoin treatment [5, 6]. We report a case of a 6-year-old girl who developed dyspnea and interim need for nasal oxygen treatment due to pulmonary fibrosis manifesting after 2 years of nitrofurantoin treatment.

*Correspondence: [email protected] Department of Paediatrics and Adolescent Medicine, Danish Center of Paediatric Pulmonology and Allergology, Aarhus University Hospital, Aarhus N, Denmark

Case presentation The 6-year-old girl was admitted to the hospital with dyspnea, general fatigue and loss of appetite developing during approximately 1 month. At admission, oxygen desaturation was 80–90% before nasal oxygen treatment. Daily and continuous treatment with oral nitrofurantoin (tablets, 25 mg/day) in combination with solifenacin (tablets) had been initiated 2 years prior to the admission to prevent recurrent urinary tract infections. She presented no other medical history. Initial blood samples revealed liver affection (p-lactic acid dehydrogenase was 199U/L and p-alanintransaminase was 750U/L), but otherwise biochemical parameters were unaffected. Multiple PCR analyses detected no microorganisms in samples from the upper respiratory tract. A computed tomography scan of the chest showed bilateral multilobar parenchymal infiltrates, g