BOOP associated with nitrofurantoin

Probable nitrofurantoin-induced bronchiolitis obliterans with organizing pneumonia

“…11 To date, eight cases, including this one, of nitrofurantoin-induced BOOP have been described in the medical literature. 5,8,10,12,13 Our patient was similar to patients in other cases in terms of drug therapy duration, onset, and symptoms. However, the duration and dosage of prednisone therapy and clinical course differ in our patient.…”

“…8 Chest radiographs consistent with BOOP usually show bilateral patchy infiltrates or groundglass attenuation with no apparent zonal distribution pattern. 10 On physical examination, crepitant rales are heard, especially over the base of the lung, and may be accompanied by dry crackles in more severe reactions, 7 as observed in our patient.…”

“…8 Occasionally, BOOP is accompanied by fever, rash, and anorexia and rarely with chest pain, cyanosis, or eosinophilia. 5,7,10 Drug-induced BOOP has been more strongly associated with nitrofurantoin, minocycline, bleomycin, amiodarone, carbamazepine, interferon alfa, tryptophan, and illicit cocaine use than with other agents. 11 To date, eight cases, including this one, of nitrofurantoin-induced BOOP have been described in the medical literature.…”

Nitrofurantoin-Induced Pulmonary Reaction Involving Respiratory Symptoms: Case Report

“…7 In most cases, administration of prednisone 30 to 40 mg daily for 5 weeks to 16 months has been associated with positive outcomes: either complete resolution or partial recovery in terms of clinical symptoms and radiographic imaging. 6,8,9,12 In 2 cases, corticosteroid therapy was ineffective, and the patients died from infectious complications. Both of these patients were ex-smokers, and the corticosteroid was tapered rapidly after initial recovery.…”

“…1,[6][7][8][9] According to available case reports, nitrofurantoin-induced BOOP is associated with long-term therapy ranging from 6 months to 4 years and is often characterized by delayed onset of symptoms. [6][7][8][9]12 In the case reported here, the score of 5 on the Naranjo Adverse Drug Reaction Probability Scale 13 indicated that the patient's BOOP was probably related to the use of nitrofurantoin. The patient had a 6-day history of nonproductive cough and dyspnea before presenting to the hospital with hypoxia and had received a total of 11 days of nitrofurantoin therapy at the time of presentation.…”