Nitrofurantoinlunge -ein Langzeitverlauf

Following a notice in the journal Deutsches Arzteblatt from July 2007 on the case of a 61 -year-old woman, who suffered fatal respiratory failure following intake of nitrofurantoin we report a case from the Zusamklinik. A 73-year-old woman had been suffering from coughing and dyspnea for six months. Due to a chronic infection of the bladder she had taken 100 mg of nitrofurantoin daily for one year. Fine endinspiratory crackles on both sides of her lungs could be heard, the lung function showed a restrictive lung disorder and a serious respiratory insufficiency. Transaminases and ANA were increased. On the conventional chest X-ray and the CT-thorax infiltrates on both sides and also small pleural effusions appeared. In a transbronchial lung biopsy a BOOP-reaction was histologically confirmed, the BAL showed 37% lymphocytes. Under treatment with steroids the patient's condition, the respiratory insufficiency, the X-ray findings and the transaminases improved. After administration of steroids for ten months, a complete reconstitution was achieved. Twelve months later, even without steroids, no symptoms occurred. Because of the history and the other findings a hypersensitive pneumonitis in combination with a drug-induced hepatitis is the most likely diagnosis, a drug-induced lupus erythematosus, however, is also possible.