Downstaging of Non–Small-Cell Lung Cancer Through Identification of Reversible Drug Toxicity

Browning, Eiko Theodora; Huckleberry, Jason; Barrow, Willis; Restauri, Nicole; Kemme, Douglas; Weyant, Michael J.; Franklin, Wilbur A.; Camidge, D. Ross

doi:10.1200/jco.2013.51.6930

Cited by 2 publications

(4 citation statements)

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“…Nitrofurantoin is an antibacterial agent commonly used for treatment and prevention of UTI. The incidence of pulmonary toxicity due to nitrofurantoin is estimated to lie between 0.0001% and 0.001% [1] . Although rare, nitrofurantoin-induced diffuse lung toxicity is one of the most commonly reported pulmonary drug toxicities, reflecting the increased popularity of the drug [2] .…”

Section: Discussionmentioning

confidence: 99%

“…Female sex, accountable for 85–95% of cases, renal impairment and older age are associated with higher risk of this toxicity [3,4] . This phenomenon is not dose-related and can have an acute onset (approximately 90% of cases) or a chronic presentation [1,3] . Chronic pulmonary toxicity is seen primarily in older women who have been prescribed relatively small doses of nitrofurantoin for UTI prevention [3,4] .…”

Section: Discussionmentioning

confidence: 99%

“…Laboratory abnormalities may include positive anti-nuclear, anti-smooth muscle and anti-neutrophil cytoplasmic antibody results [3,4] , as in our patient, and may not indicate a rheumatic disease. Bilateral and basal lung infiltrates are seen on CXR in 94% of patients [1] . The HRCT shows frequently bilateral ground-glass attenuation, irregular linear opacities, bibasal air-space consolidation and fibrosis [1,2,5] .…”

Section: Discussionmentioning

confidence: 99%

“…Bilateral and basal lung infiltrates are seen on CXR in 94% of patients [1] . The HRCT shows frequently bilateral ground-glass attenuation, irregular linear opacities, bibasal air-space consolidation and fibrosis [1,2,5] . Lung function assessment generally reveals restrictive physiology and the BAL cellular profile can reveal lymphocytosis, neutrophilia or eosinophilia [3] .…”

Section: Discussionmentioning

confidence: 99%

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Consider Nitrofurantoin as a Cause of Lung Injury

Almeida

Seixas

Pinheiro

et al. 2019

European Journal of Case Reports in Internal Medicine

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Nitrofurantoin-induced diffuse lung toxicity is well documented in the literature but is often misdiagnosed. We describe an 82-year-old female medicated with nitrofurantoin for the previous 2 years who was admitted for dyspnoea, dry cough and fatigue for 4 months. She was febrile and tachypnoeic and she presented with bilateral basal crackles, hypoxaemic respiratory failure and slightly elevated C-reactive protein levels. A chest radiograph showed bilateral air-space consolidation and interstitial infiltrates and the high-resolution computed tomography scan was evocative of a perilobular pattern of organising pneumonia (OP). Due to the clinical–radiological context, she was diagnosed with a presumable nitrofurantoin-induced OP. She was started on prednisolone 60 mg daily with a progressive improvement. It is important that clinicians are aware of the spectrum of side effects associated with nitrofurantoin so as to monitor patients.LEARNING POINTSIt is crucial to ensure that a thorough medical history with a systems review and a complete drug history are carried out.Chronic pulmonary toxicity due to nitrofurantoin is rare and it occurs primarily in older women who have been prescribed relatively small doses of nitrofurantoin for UTI prevention.The cessation of nitrofurantoin is the basis of the treatment and may be sufficient for clinical and radiological improvement.

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Section: Discussionmentioning

confidence: 99%