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Nitrofurantoin-associated Sweet's syndrome.

C R Retief1, F D Malkinson

  • 1Department of Dermatology, Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.

Cutis
|April 6, 1999
PubMed
Summary

Nitrofurantoin, an antibiotic for urinary tract infections, can trigger Sweet's syndrome, a rare inflammatory condition. This case highlights the importance of considering drug-induced reactions in patients presenting with fever, rash, and joint pain.

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Area of Science:

  • Dermatology
  • Rheumatology
  • Pharmacology

Background:

  • Sweet's syndrome is an acute febrile neutrophilic dermatosis characterized by fever, neutrophilia, and tender dermal infiltrates.
  • Drug-induced Sweet's syndrome is a recognized but uncommon presentation, with various medications implicated.
  • Nitrofurantoin is a commonly prescribed antibiotic for urinary tract infections.

Observation:

  • A 53-year-old woman developed arthralgias, fever, and a painful rash after a 7-day course of nitrofurantoin.
  • Initial skin biopsy suggested a toxic eruption, but clinical evolution and repeat biopsy confirmed Sweet's syndrome.
  • Symptoms resolved following treatment with prednisone.

Findings:

  • The patient's presentation and diagnostic workup were consistent with drug-induced Sweet's syndrome.
  • Nitrofurantoin was identified as the likely causative agent.
  • Histopathological examination confirmed the diagnosis of Sweet's syndrome.

Implications:

  • This case expands the spectrum of adverse drug reactions associated with nitrofurantoin.
  • Clinicians should consider nitrofurantoin as a potential trigger for Sweet's syndrome in patients with compatible symptoms.
  • Early recognition and withdrawal of the offending drug, along with appropriate treatment, are crucial for patient management.

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