SHM Converge Scientific Abstract ePoster Gallery-Macrobad! A Rare Complication of a Common Therapeutic

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A 79-year-old man with a history of BPH status post TURP developed several months of progressive dyspnea and dry cough after starting suppressive nitrofurantoin for recurrent UTIs six months earlier. On presentation, he was hypoxemic and in respiratory distress with diffuse inspiratory crackles. Labs showed elevated inflammatory markers and a positive ANA (1:160 speckled), but the rest of the autoimmune workup was negative.<br /><br />Chest CTA revealed both a left lower lobe segmental pulmonary embolism and widespread fibrotic organizing pneumonia with peripheral predominance, consistent with interstitial lung disease. Pulmonology determined that his respiratory failure was due primarily to nitrofurantoin-related interstitial lung disease rather than the PE. Nitrofurantoin was stopped, and he was treated with IV steroids, then discharged on a prolonged steroid taper, apixaban, and home oxygen.<br /><br />At eight-month follow-up, he had significant clinical improvement, no longer needed supplemental oxygen, and high-resolution CT showed only faint residual ground-glass opacities.<br /><br />This case highlights a rare but important adverse effect of a commonly prescribed medication. Nitrofurantoin-induced interstitial lung disease can be difficult to recognize in the hospital because symptoms are nonspecific, onset may be delayed over months, and autoimmune markers such as ANA can be misleadingly positive. Prompt recognition, medication discontinuation, and steroid treatment are key to recovery and long-term preservation of lung function.

Asset Subtitle

Joshua D. Garcia

Meta Tag

Author List Courtney Detwiler, James Rogers, Joshua D. Garcia

Category Clinical Vignettes

Concept Nitrofurantoin

Concept Interstitial Lung Disease

Concept Nitrofurantoin-Induced Interstitial Lung Disease

Concept Nitrofurantoin Discontinuation

Concept Respiratory Failure

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Joshua D. Garcia

Track Adult

Keywords

nitrofurantoin-induced interstitial lung disease

interstitial lung disease

pulmonary embolism

fibrotic organizing pneumonia

dyspnea

dry cough

positive ANA

steroid treatment

hypoxemia

home oxygen

Nitrofurantoin

Interstitial Lung Disease

Nitrofurantoin-Induced Interstitial Lung Disease

Nitrofurantoin Discontinuation

Respiratory Failure