Chronic nitrofurantoin-induced lung disease
Jose L Mendez1, Hassan F Nadrous, Thomas E Hartman
1Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Objective:
To reassess the clinical and radiological features of chronic nitrofurantoin-induced lung disease and eventual clinical outcome.
Patients And Methods:
We retrospectively reviewed the medical records of 18 patients with chronic nitrofurantoin-induced lung disease who were seen at the Mayo Clinic in Rochester, Minn, from January 1, 1997, to December 31, 2002.
Results:
The median age of the 18 patients was 72 years (range, 47-90 years) at the time of diagnosis; 17 (94%) were women. Onset of symptoms occurred after a median interval of 23 months (range, 10-144 months) following the initiation of nitrofurantoin therapy for the prevention of recurrent urinary tract infections. All patients presented with persistent dyspnea and cough associated with lung infiltrates detected on chest radiography. Ten computed tomograms were available for review and revealed bilateral areas of ground-glass opacities in all cases and showed subpleural Irregular linear opacities and patchy consolidation in some cases. Nitrofurantoin therapy was discontinued in all patients, and most improved subsequently; 9 patients received corticosteroid therapy.
Conclusions:
Chronic nitrofurantoin-induced lung disease is seen predominantly in older women who present with respiratory symptoms after a year or more of nitrofurantoin therapy. Associated radiological features are relatively nonspecific but usually include bilateral areas of ground-glass opacities on computed tomography of the chest. Cessation of nitrofurantoin therapy leads to improvement and suffices in the management of some patients, although corticosteroid therapy may be helpful in those more severely affected.
Insights
Chronic nitrofurantoin-induced lung disease primarily affects older women, presenting with respiratory symptoms after prolonged use. Discontinuing nitrofurantoin often improves lung disease, with corticosteroids aiding severe cases.
Area of Science:
- Pulmonology
- Pharmacology
- Radiology
Background:
- Nitrofurantoin is commonly prescribed for urinary tract infections.
- Chronic lung disease can be an adverse effect of long-term nitrofurantoin use.
- Understanding the clinical and radiological features is crucial for diagnosis and management.
Purpose of the Study:
- To reassess the clinical and radiological features of chronic nitrofurantoin-induced lung disease.
- To evaluate the clinical outcome of patients with this condition.
Main Methods:
- Retrospective review of medical records of 18 patients diagnosed with chronic nitrofurantoin-induced lung disease.
- Analysis of clinical symptoms, chest radiography, and computed tomography (CT) findings.
- Assessment of treatment outcomes following nitrofurantoin discontinuation and/or corticosteroid therapy.
Main Results:
- The study population comprised predominantly older women (94%) with a median age of 72 years.
- Patients experienced respiratory symptoms (dyspnea, cough) after a median of 23 months of nitrofurantoin therapy.
- Radiological findings included bilateral ground-glass opacities on CT, with some showing subpleural irregular linear opacities and patchy consolidation.
- Discontinuation of nitrofurantoin led to improvement in most patients; 9 received corticosteroid therapy.
Conclusions:
- Chronic nitrofurantoin-induced lung disease typically affects older women with prolonged nitrofurantoin use.
- Clinical presentation includes respiratory symptoms, and radiological features are often nonspecific but include bilateral ground-glass opacities.
- Cessation of nitrofurantoin is key to management, with corticosteroids beneficial for severe cases.
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