Fatal Nitrofurantoin-Induced Pulmonary Toxicity: A Potentially Preventable Medical Error

Abstract

Nitrofurantoin is a commonly prescribed urinary antiseptic both for acute treatment and prophylaxis against recurrent urinary tract infections. It is known for its safety, efficacy, tolerability and cost-effectiveness. Rarely, nitrofurantoin can cause acute and chronic lung and liver diseases. Acute pulmonary toxicity due to nitrofurantoin is more common than its chronic form and is probably a hypersensitivity reaction to the drug. In contrast, the chronic pulmonary toxicity appears to be due to cumulative drug exposure leading to chronic inflammation and fibrosis and is therefore an irreversible process. What predisposes to the rare and severe form of acute pulmonary toxicity is unknown. In this case, it appears that renal impairment may have played a role as a predisposing factor.