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Nitrofurantoin-induced alterations in pulmonary tissue. A report on five patients with acute or subacute reactions
Abstract:
Three patients with acute and two with subacute nitrofarantoin-induced pulmonary reactions were studied clinically and by examinining microcoscopically needle biopsy specimens of their lungs. In all five patients slight vasculitis and a few interstitial eosinophils were found in the pulmonary tissue 1-2 weeks after the withdrawal of nitrofurantion therapy. Alveolitis, fibrinous alveolar exudate and perivascular granulomas were also seen in some specimens. The patients with acute reactions had marked blood eosinophilia. In all patients, pulmonary diffusing capacity (DLCO) was below normal, but ventilatory function was not appreciably affected. Withdrawal of nitrofurantion resulted in complete or partial improvement in 4-8 weeks. Our clinical and histological findings support the suggestion that a type III immune-complex-mediated reactions is involved in acute and subacute hypersensitivity reactions to nitrofurantoin.
Insights
Nitrofurantoin-induced lung injury can cause vasculitis and eosinophil infiltration. This study suggests a type III immune-complex reaction mechanism in these hypersensitivity pneumonitis cases.
Area of Science:
- Pulmonology
- Immunology
- Pathology
Background:
- Nitrofurantoin is a common antibiotic used for urinary tract infections.
- Nitrofurantoin can cause pulmonary toxicity, presenting as acute or subacute hypersensitivity pneumonitis.
- The exact immunological mechanism underlying nitrofurantoin-induced lung injury is not fully understood.
Purpose of the Study:
- To investigate the clinical and histological features of nitrofurantoin-induced pulmonary reactions.
- To explore the potential immunological mechanisms involved in these reactions.
Main Methods:
- Clinical case study of five patients with acute or subacute nitrofurantoin-induced pulmonary reactions.
- Microscopic examination of lung biopsy specimens.
- Assessment of pulmonary function, including diffusing capacity for carbon monoxide (DLCO) and ventilatory function.
- Analysis of blood eosinophil counts.
Main Results:
- Histological findings included vasculitis and interstitial eosinophils in all patients.
- Alveolitis, fibrinous alveolar exudate, and perivascular granulomas were observed in some cases.
- Patients with acute reactions exhibited marked blood eosinophilia.
- Pulmonary diffusing capacity (DLCO) was reduced in all patients, while ventilatory function remained largely unaffected.
- Complete or partial improvement was noted in 4-8 weeks after nitrofurantoin withdrawal.
Conclusions:
- Clinical and histological findings support a type III immune-complex-mediated reaction in nitrofurantoin hypersensitivity pneumonitis.
- Nitrofurantoin-induced lung injury involves inflammatory and immune responses in the pulmonary tissue.