Anicteric liver damage during nitrofurantoin medication.

Area of Science:

• Hepatology
• Clinical Pharmacology
• Toxicology

Background:

• Nitrofurantoin is a commonly prescribed antibiotic.
• Drug-induced liver injury (DILI) is a significant concern.
• Anicteric hepatitis, or jaundice-free liver inflammation, can be a manifestation of DILI.

Purpose of the Study:

• To investigate the relationship between nitrofurantoin use and the development of anicteric hepatitis.
• To characterize the clinical, biochemical, and histological features of nitrofurantoin-induced liver injury.
• To assess the reversibility of liver damage after drug withdrawal.

Main Methods:

• Case series describing four patients with suspected nitrofurantoin-induced liver injury.
• Clinical assessment including serum transaminase levels and hypergammaglobulinaemia.
• Liver biopsy analysis for histological changes.
• Assessment of albumin-IgG complexes.
• Drug re-challenge in one patient.

Main Results:

• All four patients presented with elevated serum transaminases and hypergammaglobulinaemia.
• Liver biopsies were suggestive of chronic active hepatitis, with three showing cirrhotic features.
• Two patients had circulating albumin-IgG complexes.
• Serum transaminases normalized within weeks of nitrofurantoin withdrawal.
• Hypergammaglobulinaemia and biopsy findings remained largely unchanged for 2-6 months.
• Re-challenge with nitrofurantoin led to recurrent elevation of serum transaminases.

Conclusions:

• Nitrofurantoin can be associated with anicteric hepatitis and chronic liver injury.
• Liver enzyme normalization occurs after drug cessation, but histological changes may persist.
• The potential for long-term liver damage and the utility of drug re-challenge as a diagnostic tool are highlighted.