Ventilation-perfusion lung imaging in nitrofurantoin-related pulmonary reaction

A woman with a history of multiple drug allergies was admitted for cough and dyspnea. She had been taking nitrofurantoin for 10 days, was febrile, and had a rash on the trunk and extremities. A chest radiograph revealed right-sided pleural effusion and basal markings. Because of suspected nitrofurantoin-related pulmonary reaction, the medication was discontinued and the patient was started on an H2-blocker and intravenous corticosteroids. She improved clinically, and within 24 hours a radiograph revealed that her chest had largely cleared. Restricted distribution of radioxenon, seen initially on a ventilation lung scan, also reverted to near normal by the follow-up. The first perfusion lung scan showed multiple but nonspecific changes; this also came back to near normal. The nitrofurantoin-related pulmonary reaction should be considered in patients who present with pulmonary signs/symptoms while on the medication.