A RARE CASE OF NITROFURANTIOIN INDUCED AUTOIMMUNE LIKE HEPATITIS

The class of nitro furan antibiotics includes Nitrofurantoin, an agent primarily used to treat urinary tract infections. It is efficacious as it can attain therapeutic concentration in urine and elicit both bactericidal and bacteriostatic activity against both gram positive and gram-negative organisms. Hence proving its efficacy in treating lower urinary tract infections. It also shows very less resistance and although widely used it also has its side effects like rashes, loss of appetite, dizziness, fever, diarrhoea,,. It can also cause adverse reactions like pulmonary toxicity, hepatic toxicity, haemolytic anaemia but the incidence of such events is rare. Even though the occurrence of hepatotoxicity is rare, to overlook monitoring for possible liver injury may prove fatal. As nitrofurantoin is one of the most common drugs behind drug induced liver injury checking for any possible liver injury becomes crucial. The drug is also capable of presenting autoimmune features like presence of auto antibodies and may trigger autoimmune hepatitis and if not discontinued in time can lead to complications like cirrhosis or liver failure. Occurrence of drug induced autoimmune hepatitis is unusual and can considered as a phenotype of the drug. Differentiating between a drug induced mimicry of autoimmune features and idiopathic autoimmune hepatitis is very difficult. But if it is drug induced liver injury mimicking autoimmune hepatitis, discontinuation of the drug can help resolve the event. Here we present a case of a 56-year-old woman who was on a long-term treatment with nitrofurantoin against recurrent urinary tract infection for over a period of about 1 year. She was admitted with complains of yellowish discoloration of eyes and skin, dark coloured urine, abdominal pain, vomiting, edema on both legs and history of weight loss. She also had highly elevated liver enzymes. She also showed presence of autoantibody. However, her symptoms resolved on discontinuation of nitrofurantoin, liver enzymes reduced to a normal range and the patient showed response to treatment with corticosteroids and with no relapse on follow up. KEY WORDS: NITROFURANTOIN, AUTOIMMUNE HEPATITIS, DRUG INDUCED AUTOIMMUNE LIKE HEPATITIS, URINARY TRACT INFECTION, AUTOANTIBODIE