Chronic Pulmonary Reaction to Nitrofurantoin

Naomal S. Jayasundera, MD; Robert D. Johnson, MD; David P. Nicholson, MD
JAMA. 1980;243(8):769. doi:10.1001/jama.1980.03300340045020.
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ACUTE pulmonary response to short-term therapy with nitrofurantoin was described first in 1962 and was followed in 1966 by the description of a severe, debilitating, subacute pulmonary response.1 Since that time, 40 subacute and chronic pulmonary responses to long-term nitrofurantoin therapy have been recorded in the English medical literature, and biopsy specimens in some have shown the process to resemble desquamative interstitial pneumonia.1-15 It is generally considered that the correct treatment is to discontinue administration of the offending agent and substitute a course of oral corticosteroids.

Report of a Case  A 59-year-old man was seen in September 1978 with a history of productive cough and progressive dyspnea. In 1976, a right lower lobectomy following trauma had disclosed some interstitial pulmonary fibrosis. Chest x-ray films obtained on the current admission showed bilateral basilar interstitial fibrosis and pleural thickening. A previous roentgenogram in September 1977 had been normal. On this


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