Nitrofurantoin-induced pulmonary fibrosis: a case report

Natascha NT Goemaere¹ , Karin Grijm²^,3 , Peter ThW van Hal² and Michael A den Bakker¹

¹Departmentof Pathology, Josephine Nefkens Institute, Erasmus MC – University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands

²Department of Respiratory Medicine, Josephine Nefkens Institute, Erasmus MC – University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands

³Department of Respiratory Medicine, Spaarne Ziekenhuis, 2130 AT Hoofddorp, The Netherlands

author email corresponding author email

Journal of Medical Case Reports 2008, 2:169doi:10.1186/1752-1947-2-169


Published:	21 May 2008

Abstract

Introduction

Nitrofurantoin is a commonly used drug in the treatment and prevention of urinary tract infections. Many adverse effects of nitrofurantoin have been documented, including aplastic anemia, polyneuritis, and liver and pulmonary toxicity.

Case presentation

We describe the clinical history and the autopsy findings in a 51-year-old woman with lung fibrosis of unknown etiology. She had a history of recurrent urinary tract infections, treated with nitrofurantoin for many years. She was referred to our hospital for screening for lung transplantation because of severe pulmonary restriction and dyspnea. Unfortunately, she died as a result of progressive respiratory insufficiency. At autopsy bilateral patchy, sharply circumscribed fibrotic areas in the upper and lower lobes of the lungs were seen with honeycombing. Microscopically, end-stage interstitial fibrosis with diffuse alveolar damage was observed. Due to the atypical distribution of the fibrosis involving both the lower and upper lobes of the lung, the microscopic pattern of the fibrosis and the history of long-term nitrofurantoin use, we concluded that this drug induced the lung fibrosis. The recurrent urinary tract infections were probably caused by a diverticulum of the urinary bladder, which was discovered at autopsy.

Conclusion

This case shows that the use of nitrofurantoin may cause severe pulmonary disease. Patients with long-term use of nitrofurantoin should be monitored regularly for adverse pulmonary effects.