NITROFURANTOIN-INDUCED INTERSTITIAL LUNG DISEASE: WHEN URINARY TRACT INFECTION PROPHYLAXIS GOES WRONG

TOPIC: Diffuse Lung Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Nitrofurantoin is a rare cause of interstitial lung disease, although it common culprit for medication induced disease. pulmonary toxicity can present in many forms including acute to chronic pneumonia. This case highlights an insidious presentation nitrofurantoin disease that showed resolution with the discontinuation medication. CASE PRESENTATION: 74 year old female presented clinic evaluation unresolved infiltrates. She had complaints 4 months cough and progressive dyspnea on exertion. Prior consultation, she was treated by her primary care provider 2 separate courses antibiotics without any symptoms. The patient's only new recurrent urinary tract infections started 9 month prior. CT Imaging patchy areas ground glass opacity predominately upper lobes central fields bronchovascular distribution. discontinued. underwent bronchoscopy no endobronchial lesions negative cultures. Bronchial alveolar lavage (BAL) cell counts were 6% neutrophils 53% lymphocytes. diagnosis made basis clinical impression BAL counts. prednisone taper supplemental oxygen due severity Her repeat imaging demonstrated DISCUSSION: has been prescribed prophylaxis patients predisposing factors. not benign It induce toxicity, which range from variety radiologic patterns. ranges but be fatal; thus prophylactic should routinely assessed possible toxicity. CONCLUSIONS: reversible Urinary when benefits outweigh risks. Patients who develop respiratory symptoms REFERENCE #1: Mendez JL, Nadrous HF, Hartman TE. Chronic nitrofurantoin-induced Mayo Clin Proc. 2005;80(10):1298-1302. #2: Albert X, Huertas I, Pereiró II. Antibiotics preventing infection non-pregnant women. Cochrane Database Syst Rev. 2004;2004(3):CD001209. #3: Claussen K, Stocks E, Bhat D, Fish J. How Common Are Pulmonary Hepatic Adverse Effects Older Adults Prescribed Nitrofurantoin? J Am Geriatr Soc. 2017 Jun;65(6):1316-1320. DISCLOSURES: No relevant relationships Badri Giri, source=Web Response Elspeth Springsted,