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Evaluation of a Patient With a Severe Systemic Inflammatory Response to Nitrofurantoin
Brigitte Vanle1, Timothy Beatty1
1Trident Medical Center, Charleston, SC.
Background:
Nitrofurantoin is a prevalent antibiotic used to treat urinary tract infections. Despite nitrofurantoin's general safety, it can cause serious side effects, including acute pulmonary toxicity, fulminant hepatitis, and severe systemic inflammatory responses, which may mimic conditions such as ischemia and infection. However, reports of acute systemic inflammatory response syndrome after nitrofurantoin ingestion are uncommon in medical literature.
Case Presentation:
This case describes a severe systemic inflammatory response syndrome in an 85-year-old woman presenting with hypoxia, altered mental status, and profound leukocytosis after exposure to a single dose of nitrofurantoin.
Conclusion:
Herein we report on a patient with suspected bacteremia and urosepsis. Who was treated with broad-spectrum antibiotics. However, the antibiotic used to treat the patient's urinary tract infection caused an altered mental status and systemic inflammatory response. Therefore, it is crucial for clinicians to consider iatrogenic and medication-induced etiologies for altered mental status.
Insights
Nitrofurantoin can cause rare but severe systemic inflammatory responses, mimicking sepsis. Clinicians must consider this antibiotic as a potential cause of altered mental status and inflammation in elderly patients.
Area of Science:
- Pharmacology
- Internal Medicine
- Critical Care Medicine
Background:
- Nitrofurantoin is a common antibiotic for urinary tract infections.
- While generally safe, it can cause severe side effects like pulmonary toxicity and hepatitis.
- Acute systemic inflammatory response syndrome (SIRS) is a rare but serious adverse effect.
Observation:
- An 85-year-old woman developed SIRS after a single nitrofurantoin dose.
- Symptoms included hypoxia, altered mental status, and severe leukocytosis.
- Her condition mimicked sepsis and ischemia.
Findings:
- The patient's presentation was attributed to nitrofurantoin-induced SIRS.
- This highlights a rare but critical adverse drug reaction.
- The case underscores the importance of considering iatrogenic causes.
Implications:
- Clinicians should consider nitrofurantoin as a potential cause of SIRS.
- Differential diagnosis for altered mental status in elderly patients should include drug reactions.
- Awareness of this rare side effect is crucial for patient safety.
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