Pulmonary and hepatic toxicity due to nitrofurantoin

Aim: To present a case of combined pulmonary and hepatic toxicity due to nitrofurantoin. Clinical features: A 79-year-old female developed painless jaundice and exertional dyspnoea over an 8-week period. A chest X-ray and computerised tomography chest scan revealed interstitial lung disease with respiratory function tests showing a markedly reduced diffusing lung capacity for carbon monoxide (6.72 mL/min/mmHg). Liver function tests were markedly elevated, consistent with acute hepatitis, but returned to normal following cessation of the drug. Discussion: Combined hepatic and pulmonary toxicity due to nitrofurantoin is rare. The mechanism for pulmonary toxicity is thought to be secondary to the generation of oxygen free radicals in combination with immune-mediated injury. An immune mechanism is similarly thought to cause the hepatic toxicity