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Concomitant Nitrofurantoin-Induced Autoimmune Hepatitis and Interstitial Lung Disease

Andreia Carvalho de Matos1,2, Cristiane Pais Macedo1, Patrícia Afonso Mendes1,2

  • 1Internal Medicine Department, Coimbra Hospital and University Center, Coimbra, Portugal.

GE Portuguese Journal of Gastroenterology
|August 18, 2022
PubMed

Insights

Nitrofurantoin can cause rare autoimmune hepatitis and lung fibrosis, even with antibiotic prophylaxis for urinary tract infections. This case highlights the importance of considering drug toxicity in patients with multiple organ symptoms.

Area of Science:

  • Toxicology
  • Hepatology
  • Pulmonology

Background:

  • Adverse drug reactions from antibiotics can present with nonspecific symptoms, delaying diagnosis.
  • Establishing a direct link between a specific toxin and its effects is challenging due to multiple circulating substances.

Observation:

  • A 68-year-old woman developed progressive dyspnea and jaundice after prolonged nitrofurantoin use for urinary tract infection prophylaxis.
  • The patient presented with symptoms suggestive of multi-organ involvement.

Findings:

  • The case demonstrates concomitant autoimmune hepatitis and lung fibrosis definitively linked to nitrofurantoin toxicity.
  • Histological, imagiological, and immunological evidence confirmed nitrofurantoin-induced organ damage.

Implications:

  • This case underscores the potential for nitrofurantoin to induce severe autoimmune hepatitis and lung fibrosis.
  • Clinicians should consider drug-induced toxicity, specifically nitrofurantoin, in patients presenting with unexplained multi-organ symptoms.
Keywords:
Autoimmune hepatitisInterstitial pulmonary diseaseNitrofurantoin toxicity

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