Nitrofurantoin-Induced Acute Liver Damage in Pregnancy

Abstract

This article presents a rare case of acute toxic hepatitis in thirty-one-year old primigravida. In the 36 th week of gestation, the patient was introduced nitrofurantoin 100 mg a day due to symptoms of dysuria and enterococcus isolated from urine culture. After induced delivery at term because of hypertension, repeated laboratory fi ndings showed increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and negative hepatitis C and B markers. The patient was subicteric at the time. Coagulation and complete blood count values were within the normal range. Nitrofurantoin therapy was discontinued. Abdominal ultrasound was normal with the exception of a slight hepatomegaly without any lesions, focal or diffuse. Given that discontinuation of nitrofurantoin and introduction of methylprednisolon therapy signifi cantly lowered liver enzyme levels, restoring most of them to normal, we concluded that this was probably the case of toxic liver damage caused by nitrofurantoin.

Nitrofurantoin: friend or foe?

“…Our patient noticed jaundice after only after 3–4 days of drug exposure, and presented after 5 days with laboratory evidence of liver injury. We found one other report6 of a 31-year-old primigravida woman who received 100 mg nitrofurantoin daily for symptoms of dysuria and subsequent Enterococcus grown in a urine sample. Similarly to our patient, she was admitted to the hospital with elevated liver enzymes, ALP, bilirubin and normal coagulation profile (hepatitis panel negative) after 10 days of antibiotic therapy.…”

Nitrofurantoin-Associated Lung and Liver Toxicity Leading to Liver Transplantation in a Middle-Aged Patient

“…Liver biochemistry tests suggested hepatocellular with occasional mixed cholestatic-hepatocellular abnormalities, and liver biopsy often indicated a pattern of chronic active hepatitis. 12 Only a handful of case reports of nitrofurantoin-associated hepatotoxicity have been published since 1988, [31][32][33][34][35][36] and the clinical picture from these more recent cases was similar to that summarized by Stricker and others. 12 The mechanism or mechanisms of pulmonary and hepatic toxicity remain unknown.…”

Medicamentos causantes de hepatotoxicidad en el embarazo: revisión estructurada

“…El tiempo de aparición de las reacciones tóxicas después de administrado el medicamento para los antitiroideos (40) o el acetaminofén (14) se estimó en días, mientras que para medicamentos como el saquinavir (22), la alfametildopa (16) o el piperidolato (49), el orden fue de meses. Estas reacciones hepatotóxicas aparecieron cuando las pacientes tenían alrededor de la tercera semana de embarazo en el caso del metotrexato (18), y cuando las pacientes se encontraban en la décima o más semanas de embarazo para acetaminofén, alfametildopa, nitrofurantoína, nevirapina, saquinavir y antitiroideos (16,22,33,46,48).…”

“…En este contexto, en el caso del acetaminofén, la nitrofurantoína, la alfametildopa y la nevirapina, el aumento en los valores de la aspartato-aminotransferasa (AST) y alanino-aminotranferasa (ALT) fue mayor de 10 veces el límite superior normal (7,14,16,48). Además, otros síntomas inespecíficos, como la ictericia, los vómitos, el prurito y la anorexia, pueden aparecer en estas pacientes (15,16,34,40).…”

“…La única manifestación presentada fue la elevación de las transaminasas. Luego de suspender el medicamento, tuvo una evolución favorable (48).…”