Nitrofurantoin-induced lung disease and prophylaxis of urinary tract infections

Abstract

Nitrofurantoin is commonly used for the treatment and prophylaxis of recurrent urinary tract infections (UTIs). Although relatively rare, nitrofurantoin is one of the commonest causes of drug-induced pulmonary disease, which can be potentially serious and even fatal. Knowledge of such potential adverse effects is essential to enable early recognition and withdrawal of the drug. Patients on long-term nitrofurantoin should be reviewed and monitored regularly. Management involves early consideration of the condition, and prompt withdrawal of the drug. We report three cases of nitrofurantoin-induced lung disease in patients who were on long-term nitrofurantoin for UTI prophylaxis and present a brief review of the literature on this subject.

Figure 1. Case 1: CT scan showing reticulonodular changes affecting the mid zones bilaterally

Figure 2. Case 2: CXR showing extensive reticular changes bilaterally

Figure 3. Case 2: HRCT showing bibasal and subpleural intra-lobular septal thickening, with some groundglass opacity and small bilateral pleural effusions

Figure 4. Case 3: CXR showing reticular changes in both bases and midzones