Nitrofurantoin-Induced Pulmonary Eosinophilia

Abstract

Honey Desai, Sonia Singh and Bhavin Vyas

Nitrofurantoin is an antibiotic used in the treatment and prevention of urinary tract infections (UTIs). However, one serious and rare adverse effect is nitrofurantoin-induced pulmonary eosinophilia (NIPE) - a disease caused by abnormal accumulation of certain white blood cells and Immunoglobulin E (IgE) in the lungs that results in cough, shortness of breath, chest tightness and tiredness. This case report presents a patient who starts experiencing cough, dyspnea, and fatigue after taking nitrofurantoin for a urinary tract infection. This case underlines the possibility of serious adverse drug reactions of nitrofurantoin-induced pulmonary eosinophilia even with such common dosage and treatment duration. The existing complexity in the patient's history (DM type 2, CKD stage 4, COPD) may have predisposed them to develop NIPE. It highlights the need for close follow-up for adverse effects, especially for patients with multiple comorbidities and those prescribed with polypharmacy. While NIPE is a known adverse effect of nitrofurantoin, this case report adds to the current literature by 1) Presenting a case in a patient with multiple comorbidities; 2) Highlighting how careful medication reconciliation and potential drug interactions should be considered; and 3) Stressing the continued alertness in monitoring for adverse drug reactions, even with commonly used medications. Major clinical findings were high levels of IgE in urine, increased absolute eosinophil count, and a diagnosis of NIPE on clinical scenario, laboratory tests, and timing to nitrofurantoin use. The diagnoses henceforth made was NIPE, DM type 2, CKD stage 4, COPD, and UTI. Measures in such cases included withdrawal of nitrofurantoin, bronchodilators, corticosteroids; management of underlying disorders such as diabetes, CKD; and supportive therapy refer to patient response to treatment (e.g., improvement in respiratory symptoms, resolution of eosinophilia) and the long-term impact of NIPE on the patient's pulmonary function, where available.

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