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Nitrofurantoin: friend or foe?
Nicole Kapral1, Rovin Saxena1, Anupam Ashutosh Sule1
1Internal Medicine, St Joseph Mercy Oakland, Pontiac, Michigan, USA.
BMJ Case Reports
|August 18, 2018
Summary
Nitrofurantoin can cause acute liver failure, even with short-term use for urinary tract infections. This rare side effect highlights the need for careful patient monitoring during antibiotic treatment.
Area of Science:
- Pharmacology
- Hepatology
- Infectious Diseases
Background:
- Nitrofurantoin is a primary treatment for uncomplicated cystitis and recurrent urinary tract infections.
- Drug-induced liver injury (DILI) from nitrofurantoin can manifest acutely or chronically.
- Acute DILI is rare, occurring in approximately 3 in 1,000,000 cases.
Observation:
- A 69-year-old male presented with jaundice and elevated liver enzymes after five days of nitrofurantoin for cystitis.
- The patient was admitted for chronic obstructive pulmonary disease exacerbation.
- Investigations for infectious, autoimmune, and cholestatic causes of liver injury were negative.
Findings:
- The patient experienced acute liver failure attributed to short-term nitrofurantoin use.
- Liver enzymes normalized, and jaundice resolved after drug discontinuation and a 10-day course of methylprednisolone.
- The exact mechanism of nitrofurantoin-induced hepatotoxicity remains unclear, but an autoimmune process is suspected.
Implications:
- This case highlights the potential for acute liver failure with short-term nitrofurantoin administration, a condition with limited reported data.
- Steroids may be a potential treatment modality for nitrofurantoin-induced hepatotoxicity.
- Diagnosis is challenging and relies on excluding other causes, with drug rechallenge being the only definitive diagnostic method.
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