NITROFURANTOIN LUNG DISEASE

CLUES TO PATHOGENESIS

¹ Resident in Radiology, Massachusetts General Hospital
² Assistant Professor of Radiology at the Massachusetts General Hospital; Director, White Building Radiology, and Associate Radiologist, Massachusetts General Hospital

A clinical syndrome consisting of chills, fever, cough, dyspnea, and chest pain can be manifested following the administration of nitrofurantoin. The associated roentgenograms of the chest reveal an irregular increase in the interstitial markings in the lungs demonstrated by a coarse, reticular pattern, most prominent at the bases; pleural effusions may be present. Alveolar infiltrates and cardiomegaly are not seen.

The lung changes can be ascribed to an allergic hypersensitivity phenomenon in which the subsequent capillary damage permits the transudation of fluid into the interstitial septa, resulting in interstitial edema. The rapid reversion of the lung changes to normal in acute cases indicates that the septal thickening could not be secondary to an interstitial pneumonitis.

In the chronic form of the disease, the prolonged presence of fluid in the interstitium attracts inflammatory cells and can lead to interstitial fibrosis.

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