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Nitrofurantoin: cause of DRESS syndrome

Rodrigo Nazário Leão1, Paulo Barreto, Ricardo R Leão

  • 1Department of Internal Medicine, Centro Hospitalar Lisboa Central, EPE, Lisboa, Portugal. rodrigoromaoleao@gmail.com

BMJ Case Reports
|May 11, 2013
PubMed

Insights

Nitrofurantoin, a common UTI antibiotic, can cause DRESS syndrome (drug reaction with eosinophilia and systemic symptoms). This case highlights potential severe adverse reactions in elderly patients, even with low-side-effect drugs.

Area of Science:

  • Pharmacology
  • Nephrology
  • Dermatology

Background:

  • Urinary tract infections (UTIs) are prevalent in the elderly.
  • Antibiotic resistance necessitates careful drug selection.
  • Nitrofurantoin is frequently prescribed for UTIs due to its safety profile.

Observation:

  • A 77-year-old woman developed a widespread skin rash and decreased urine output during nitrofurantoin treatment for a UTI.
  • The patient presented with eosinophilic pneumonia, anemia, and renal impairment.
  • These symptoms were attributed to nitrofurantoin administration.

Findings:

  • This case report suggests nitrofurantoin as a potential cause of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome.
  • The patient's presentation included dermatological, pulmonary, hematological, and renal manifestations.
  • This is the second reported case linking nitrofurantoin to DRESS syndrome.

Implications:

  • Clinicians should be aware of the potential for nitrofurantoin to induce DRESS syndrome, even in elderly patients.
  • Early recognition and discontinuation of the offending drug are crucial for managing DRESS syndrome.
  • Further investigation may be warranted to understand the mechanisms underlying nitrofurantoin-induced DRESS syndrome.

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