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Recurrent nitrofurantoin-induced giant cell interstitial pneumonia: Case report and literature review.

Lee B, Balavenkataraman A, Sanghavi D, Walter K - Respir Med Case Rep (2015)

Bottom Line: Only two cases of GIP induced by nitrofurantoin have been reported in the medical literature.We are reporting a case of recurrent nitrofurantoin-induced GIP.Although extremely rare, GIP needs to be included in the differential diagnosis in patients with chronic nitrofurantoin use who present with respiratory illness.

View Article: PubMed Central - PubMed

Affiliation: Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA.

ABSTRACT
Giant cell interstitial pneumonia (GIP) is a rare form of chronic interstitial pneumonia typically associated with hard metal exposure. Only two cases of GIP induced by nitrofurantoin have been reported in the medical literature. We are reporting a case of recurrent nitrofurantoin-induced GIP. Although extremely rare, GIP needs to be included in the differential diagnosis in patients with chronic nitrofurantoin use who present with respiratory illness.

No MeSH data available.


Related in: MedlinePlus

A: PFT performed approximately 2 months after the initial hospitalization shows a severe obstructive and a moderate restrictive ventilation defect and moderately decreased DLCO. B: PFT performed approximately 4 months later shows a significant improvement with a mild restrictive ventilatory defect, resolution of the obstructive ventilatory defect and only a mildly reduced DLCO.
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fig6: A: PFT performed approximately 2 months after the initial hospitalization shows a severe obstructive and a moderate restrictive ventilation defect and moderately decreased DLCO. B: PFT performed approximately 4 months later shows a significant improvement with a mild restrictive ventilatory defect, resolution of the obstructive ventilatory defect and only a mildly reduced DLCO.

Mentions: Nitrofurantoin was stopped on the day of hospital admission. The patient underwent video-assisted thoracoscopy (VATS) with lung and pleural biopsy to establish a diagnosis. The routine aerobic and anaerobic, fungal and mycobacterial cultures from the lung tissue and pleural fluid were all negative. A biopsy specimen from left lower lung demonstrated marked interstitial chronic inflammation, subpleural interstitial fibrosis and numerous prominent multi-nucleated giant cells, consistent with Giant Cell Interstitial Pneumonia (Fig. 3A and B). Since he had no exposure to hard metals, GIP was determined to be due to chronic nitrofurantoin use. He was treated with prednisone 60 mg daily and weaned off steroids over the course of 6 months. His dyspnea on exertion gradually resolved and he was weaned off oxygen as an outpatient. During a visit to pulmonary clinic five months after his initial hospitalization he was noted to have no shortness of breath at rest or with exertion. He was walking 4–5 miles per day and SpO2 was 99% on room air. On a 6-min walk testing, the lowest oxygen saturation on room air was 93%. His physical exam was normal other than mild crackles noted at the right lung base. CXR at that time showed a significant decrease in the pulmonary infiltrates and pleural thickening (Fig. 4). Pulmonary Function Testing (PFT) performed soon after hospital discharge showed a severe obstructive and moderate restrictive ventilatory defect which improved significantly on follow-up PFT performed five months later (Fig. 6A and B).


Recurrent nitrofurantoin-induced giant cell interstitial pneumonia: Case report and literature review.

Lee B, Balavenkataraman A, Sanghavi D, Walter K - Respir Med Case Rep (2015)

A: PFT performed approximately 2 months after the initial hospitalization shows a severe obstructive and a moderate restrictive ventilation defect and moderately decreased DLCO. B: PFT performed approximately 4 months later shows a significant improvement with a mild restrictive ventilatory defect, resolution of the obstructive ventilatory defect and only a mildly reduced DLCO.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356049&req=5

fig6: A: PFT performed approximately 2 months after the initial hospitalization shows a severe obstructive and a moderate restrictive ventilation defect and moderately decreased DLCO. B: PFT performed approximately 4 months later shows a significant improvement with a mild restrictive ventilatory defect, resolution of the obstructive ventilatory defect and only a mildly reduced DLCO.
Mentions: Nitrofurantoin was stopped on the day of hospital admission. The patient underwent video-assisted thoracoscopy (VATS) with lung and pleural biopsy to establish a diagnosis. The routine aerobic and anaerobic, fungal and mycobacterial cultures from the lung tissue and pleural fluid were all negative. A biopsy specimen from left lower lung demonstrated marked interstitial chronic inflammation, subpleural interstitial fibrosis and numerous prominent multi-nucleated giant cells, consistent with Giant Cell Interstitial Pneumonia (Fig. 3A and B). Since he had no exposure to hard metals, GIP was determined to be due to chronic nitrofurantoin use. He was treated with prednisone 60 mg daily and weaned off steroids over the course of 6 months. His dyspnea on exertion gradually resolved and he was weaned off oxygen as an outpatient. During a visit to pulmonary clinic five months after his initial hospitalization he was noted to have no shortness of breath at rest or with exertion. He was walking 4–5 miles per day and SpO2 was 99% on room air. On a 6-min walk testing, the lowest oxygen saturation on room air was 93%. His physical exam was normal other than mild crackles noted at the right lung base. CXR at that time showed a significant decrease in the pulmonary infiltrates and pleural thickening (Fig. 4). Pulmonary Function Testing (PFT) performed soon after hospital discharge showed a severe obstructive and moderate restrictive ventilatory defect which improved significantly on follow-up PFT performed five months later (Fig. 6A and B).

Bottom Line: Only two cases of GIP induced by nitrofurantoin have been reported in the medical literature.We are reporting a case of recurrent nitrofurantoin-induced GIP.Although extremely rare, GIP needs to be included in the differential diagnosis in patients with chronic nitrofurantoin use who present with respiratory illness.

View Article: PubMed Central - PubMed

Affiliation: Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA.

ABSTRACT
Giant cell interstitial pneumonia (GIP) is a rare form of chronic interstitial pneumonia typically associated with hard metal exposure. Only two cases of GIP induced by nitrofurantoin have been reported in the medical literature. We are reporting a case of recurrent nitrofurantoin-induced GIP. Although extremely rare, GIP needs to be included in the differential diagnosis in patients with chronic nitrofurantoin use who present with respiratory illness.

No MeSH data available.


Related in: MedlinePlus