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February 22, 1980

Chronic Pulmonary Reaction to Nitrofurantoin

Author Affiliations

From the Veterans Administration Medical Center, North Little Rock Division, and the Department of Medicine, University of Arkansas for Medical Sciences, Little Rock.

JAMA. 1980;243(8):769. doi:10.1001/jama.1980.03300340045020

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