Nitrofurantoin Induced Liver Injury

Drug induced liver injury is a recognised cause of acute liver failure. A wide range of drugs have been implicated, of which the most common are Paracetamol and antibiotics. Nitrofurantoin is a commonly prescribed antimicrobial which may cause liver injury from either acute or chronic exposure. This complication was thought to occur with an extremely low incidence; however recent data suggests that it may be significantly more common. We present a case of Nitrofurantoin induced liver injury in a 78 year old lady due to prophylactic use for 12 months with full resolution following withdrawal of the offending agent. Discussion and review of the literature includes the low incidence and how this may be a substantially more regular occurrence than previously described, treatment by withdrawal of the causative agent and prognosis which is generally good, however cirrhosis and death have both been reported. The pattern of injury and clinical features are also reviewed, both of which are extremely variable but may be defined in relation to acute or chronic features.