Missed identification of lung fibrosis resulting from nitrofurantoin: a clinical misstep
Introduction: Nitrofurantoin is an antibiotic with a broad range of effectiveness, often prescribed for preventing and treating urinary tract infections, especially in older adults and those with weakened immunity.1 Although effective, prolonged use can lead to uncommon but serious side effects, inc...
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Elsevier
2025-07-01
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| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825001526 |
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| author | Vishalini A Venkatachalam Elaine Tang |
| author_facet | Vishalini A Venkatachalam Elaine Tang |
| author_sort | Vishalini A Venkatachalam |
| collection | DOAJ |
| description | Introduction: Nitrofurantoin is an antibiotic with a broad range of effectiveness, often prescribed for preventing and treating urinary tract infections, especially in older adults and those with weakened immunity.1 Although effective, prolonged use can lead to uncommon but serious side effects, including pulmonary and liver damage. Nitrofurantoin-induced lung disease is a known, but often overlooked issue, which may manifest as either acute hypersensitivity or a slow-developing fibrotic condition.2,3 This case underscores the dangers of missed recognition and stresses the importance of careful monitoring for patients receiving long-term antibiotic treatment. Case study: A 76-year-old patient with chronic obstructive pulmonary disease (COPD) and vascular dementia was on a long-term nitrofurantoin regimen to prevent repeated urinary tract infections. The patient was admitted to the hospital with shortness of breath, a productive cough and fever. A chest X-ray showed bilateral reticular patterns and consolidation, leading to a pneumonia diagnosis (Fig 1). After 4 months, the patient had a similar episode with worsening X-ray results, but nitrofurantoin was continued without consideration of its role in potential lung disease. On a third hospital visit with recurring symptoms and further deterioration on chest X-ray (Fig 2), the possibility of lung fibrosis resulting from nitrofurantoin was considered. Previous spirometry tests indicated severe restrictive lung issues. Given the patient's frail condition, further tests were considered inappropriate, and nitrofurantoin was discontinued.4 Follow-up respiratory reviews suggested drug-induced fibrotic lung disease as the likely cause, with continued worsening seen in radiographic images. Sadly, the patient passed away a few months later. Conclusion: This case highlights the critical need for early detection of lung fibrosis caused by nitrofurantoin, particularly in older patients or those with existing lung conditions. Its vague symptoms often lead to misdiagnosis, causing delays in treatment, including discontinuation of the drug, causing permanent lung damage.4,5 Therefore, it is crucial for healthcare providers to maintain a high level of awareness and suspicion to prevent iatrogenic complications and subsequent mortality.2-5 |
| format | Article |
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| institution | DOAJ |
| issn | 1470-2118 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Medicine |
| spelling | doaj-art-537d556d31274ad9b175c19cf57f83102025-08-20T02:47:13ZengElsevierClinical Medicine1470-21182025-07-0125410043410.1016/j.clinme.2025.100434Missed identification of lung fibrosis resulting from nitrofurantoin: a clinical misstepVishalini A Venkatachalam0Elaine Tang1Manchester University NHS Foundation TrustManchester University NHS Foundation TrustIntroduction: Nitrofurantoin is an antibiotic with a broad range of effectiveness, often prescribed for preventing and treating urinary tract infections, especially in older adults and those with weakened immunity.1 Although effective, prolonged use can lead to uncommon but serious side effects, including pulmonary and liver damage. Nitrofurantoin-induced lung disease is a known, but often overlooked issue, which may manifest as either acute hypersensitivity or a slow-developing fibrotic condition.2,3 This case underscores the dangers of missed recognition and stresses the importance of careful monitoring for patients receiving long-term antibiotic treatment. Case study: A 76-year-old patient with chronic obstructive pulmonary disease (COPD) and vascular dementia was on a long-term nitrofurantoin regimen to prevent repeated urinary tract infections. The patient was admitted to the hospital with shortness of breath, a productive cough and fever. A chest X-ray showed bilateral reticular patterns and consolidation, leading to a pneumonia diagnosis (Fig 1). After 4 months, the patient had a similar episode with worsening X-ray results, but nitrofurantoin was continued without consideration of its role in potential lung disease. On a third hospital visit with recurring symptoms and further deterioration on chest X-ray (Fig 2), the possibility of lung fibrosis resulting from nitrofurantoin was considered. Previous spirometry tests indicated severe restrictive lung issues. Given the patient's frail condition, further tests were considered inappropriate, and nitrofurantoin was discontinued.4 Follow-up respiratory reviews suggested drug-induced fibrotic lung disease as the likely cause, with continued worsening seen in radiographic images. Sadly, the patient passed away a few months later. Conclusion: This case highlights the critical need for early detection of lung fibrosis caused by nitrofurantoin, particularly in older patients or those with existing lung conditions. Its vague symptoms often lead to misdiagnosis, causing delays in treatment, including discontinuation of the drug, causing permanent lung damage.4,5 Therefore, it is crucial for healthcare providers to maintain a high level of awareness and suspicion to prevent iatrogenic complications and subsequent mortality.2-5http://www.sciencedirect.com/science/article/pii/S1470211825001526 |
| spellingShingle | Vishalini A Venkatachalam Elaine Tang Missed identification of lung fibrosis resulting from nitrofurantoin: a clinical misstep Clinical Medicine |
| title | Missed identification of lung fibrosis resulting from nitrofurantoin: a clinical misstep |
| title_full | Missed identification of lung fibrosis resulting from nitrofurantoin: a clinical misstep |
| title_fullStr | Missed identification of lung fibrosis resulting from nitrofurantoin: a clinical misstep |
| title_full_unstemmed | Missed identification of lung fibrosis resulting from nitrofurantoin: a clinical misstep |
| title_short | Missed identification of lung fibrosis resulting from nitrofurantoin: a clinical misstep |
| title_sort | missed identification of lung fibrosis resulting from nitrofurantoin a clinical misstep |
| url | http://www.sciencedirect.com/science/article/pii/S1470211825001526 |
| work_keys_str_mv | AT vishaliniavenkatachalam missedidentificationoflungfibrosisresultingfromnitrofurantoinaclinicalmisstep AT elainetang missedidentificationoflungfibrosisresultingfromnitrofurantoinaclinicalmisstep |