Chronic Nitrofurantoin-Induced Lung Injury

This case features a 95-year-old woman presenting with dyspnea and dry cough of 4 weeks’ duration, without fever. She had been on daily nitrofurantoin for 6 months to prevent recurrent UTIs. Oxygen saturation was 83% on room air. Physical exam revealed inspiratory crackles in the upper lung fields. Labs showed neutrophilic leukocytosis, with no eosinophilia or liver enzyme elevation. Imaging findings included:

Chest radiograph: Patchy alveolar opacities in the upper lobes (Panel A)

Chest CT: Ground-glass and reticular opacities with upper-lobe predominance and moderate bronchiectasis (Panel B) Negative microbiologic testing ruled out infection. A diagnosis of chronic nitrofurantoin-induced lung injury was made. Nitrofurantoin was discontinued, and a prednisone taper was initiated. One week later, symptoms had improved. Two-month follow-up imaging showed near resolution of opacities (Panel C) and stabilization of bronchiectasis (Panel D).

This case features a 95-year-old woman presenting with dyspnea and dry cough of 4 weeks’ duration, without fever. She had been on daily nitrofurantoin for 6 months to prevent recurrent UTIs. Oxygen saturation was 83% on room air. Physical exam revealed inspiratory crackles in the upper lung fields. Labs showed neutrophilic leukocytosis, with no eosinophilia or liver enzyme elevation. Imaging findings included:

Chest radiograph: Patchy alveolar opacities in the upper lobes (Panel A)

Chest CT: Ground-glass and reticular opacities with upper-lobe predominance and moderate bronchiectasis (Panel B) Negative microbiologic testing ruled out infection. A diagnosis of chronic nitrofurantoin-induced lung injury was made. Nitrofurantoin was discontinued, and a prednisone taper was initiated. One week later, symptoms had improved. Two-month follow-up imaging showed near resolution of opacities (Panel C) and stabilization of bronchiectasis (Panel D).