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Transient reverse ventilation-perfusion mismatch in acute pulmonary nitrofurantoin reaction
1Ondokuz Mayts University Hospital, Department of Nuclear Medicine, Samsun, Turkey.
Insights
Hypersensitivity to nitrofurantoin can cause acute lung injury, presenting as reversible ventilation defects on lung scans. Prompt drug withdrawal leads to rapid symptom improvement and normal scan results.
Area of Science:
- Pulmonary Medicine
- Radiology
- Pharmacology
Background:
- A 67-year-old woman with myocardial infarct history presented with dyspnea, cough, nausea, and fever.
- Initial chest X-ray showed bilateral alveolar and interstitial infiltrates.
- Cardiac function was normal, prompting further investigation for pulmonary embolism.
Observation:
- Ventilation/perfusion (V/Q) scans revealed multiple bilateral ventilation defects with normal perfusion.
- The patient was recently prescribed nitrofurantoin for a urinary tract infection.
- Pulmonary hypersensitivity to nitrofurantoin was suspected.
Findings:
- Nitrofurantoin was discontinued, and supportive treatment was initiated.
- Clinical symptoms resolved within 24 hours, with marked improvement on follow-up chest X-rays.
- Repeat V/Q scans 48 hours post-discontinuation were normal, indicating reversible lung changes.
Implications:
- Acute pulmonary reactions to nitrofurantoin should be considered in patients presenting with respiratory symptoms.
- Reversible ventilation defects on lung scintigraphy can be a key finding in nitrofurantoin-induced lung injury.
- Early recognition and drug withdrawal are crucial for managing drug-related pulmonary toxicity.
Abstract:
A 67-yr-old woman with a history of myocardial infarct was admitted to emergency for marked dyspnea, nonproductive cough, nausea and fever. The thorax X-ray revealed a bilateral alveolar and interstitial infiltration pattern with basal accentuation. The cardiac examinations were normal. Technegas ventilation and Tc-99m-macroaggregated albumin (MAA) perfusion scans were performed to rule out pulmonary embolism. Bilateral multiple ventilation defects with normal perfusion was observed. The patient had been taking nitrofurantoin for four days for a bladder infection. Hypersensitivity to nitrofurantoin was suspected and the drug was discontinued. An antihistaminic and anxiolytic medication was started. The majority of the clinical symptoms disappeared within 24 hours. The control chest X-rays disclosed a marked improvement. Ventilation and perfusion scans obtained 48 hours after nitrofurantoin withdrawal were normal. The drug-related pulmonary reactions should be taken into account in patients on medication. Reversible ventilation defects can be the only lung-scintigraphic finding encountered in acute pulmonary nitrofurantoin reaction.