Two unusual pathological reactions to nitrofurantoin: case reports

Abstract

Idiosyncratic pulmonary reactions to nitrofurantoin are not unusual, often presenting as eosinophilic pneumonia. We report two cases of uncommon pathological reactions, one resembling a hypersensitivity pneumonitis and the other mimicking a giant cell interstitial pneumonia.

Severe Nitrofurantoin-Induced Lung Toxicity

“…2 Subsequently, cases of bronchiolitis obliterans with organizing pneumonia (BOOP), 3 pulmonary infiltrates with eosinophilia (PIE) syndrome, 4 diffuse alveolar hemorrhage, 5 diffuse alveolar damage (DAD), 6 and acute, subacute, and chronic interstitial lung disease have been reported. 7 Two forms of nitrofurantoin-induced lung injury have been described: acute and chronic. The acute form is a hypersensitivity reaction (type I or III), 8 clinically characterized by fever (82%), dyspnea (60%), cough (43%), rash (20%), chest pain, and cyanosis.…”

Pneumonia eosinofílica crônica secundária ao uso prolongado de nitrofurantoína: achados da tomografia computadorizada de alta resolução do tórax

“…(1) Since then, there have been various reports of nitrofurantoin-induced pulmonary reactions, with polymorphic profiles that include pulmonary fibrosis, (2,3) alveolar hemorrhage, (4) bronchiolitis obliterans organizing pneumonia (BOOP), (5) lupus-like syndrome, (6) desquamative, usual, and nonspecific interstitial pneumonias, (7) allergic reactions, (8) diffuse alveolar damage, (9) and eosinophilic pneumonia. (10) Nitrofurantoin-induced pulmonary disease has two principal forms of presentation: the acute form, which is more common, develops hours to days after the use of the medication, and is probably related to a hypersensitivity reaction or to an immunologcosteroid therapy previously performed in another facility was unsuccessful, and an open-lung biopsy was then performed, resulting in a histopathological diagnosis of diffuse interstitial fibrosis.…”

Rapid diagnosis of acute eosinophilic pneumonia (AEP) in a patient with respiratory failure using bronchoalveolar lavage (BAL) with calcofluor white (CW) staining

“…Eosinophilic pneumoniae have multiple etiologies (Table 1) and overlapping clinical presentations and findings (20). AEP has been associated with inhalation of Scotchguard (1,1,1-trichloroethane) (21), heroin (22), or stainless steel dust containing 0.1% nickel (23); with exposure to red spider allergens (24) or radiographic contrast (25); with infection with human immunodeficiency virus (26), Trichosporon terrestre (27), Toxocara canis (28,29), Trichosporon cutaneum (30), Trichoderma viridae (30,31), Aspergillus species (30,32), Mycobacterium tuberculosis (33), Coxsackie A2 virus, or Pseudomonas maltophilia (32); with treatment with acetaminophen (34), bleomycin (35), loxoprofen (36), minocycline (37)(38)(39)(40), naproxen (41), nitrofurantoin (42), pentamidine (43), salazopyrin (44), sulfadoxine (45), sulfasalazine (46,47), or tolfenamic acid (48). The current patient smoked cigarettes, as did up to 80% of AEP patients in prior reports (3,4,7,16).…”