Pleuropneumonic Reactions to Nitrofurantoin

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Abstract
Approximately 200 cases of pulmonary sensitivity reaction to nitrofurantoin have been reported since 1959. The acute reaction commonly begins with fever, cough and dyspnea; eosinophilia or skin manifestations often follow. X-ray study typically shows infiltration, especially in the lung bases, with consolidation or effusion. No deaths because of this reaction have been reported. The condition is distinguishable from Löffler's syndrome by its abrupt onset and rapid clearing, as well as by other features. It has been confused with pulmonary embolism, congestive heart failure and other cardiopulmonary diseases but may be differentiated by electrocardiography and other methods and signs. Specific treatment probably is unnecessary in most cases, since recovery usually is rapid once the nitrofurantoin is withdrawn, but antihistamines and corticosteroids have been effective for symptomatic relief. A small number of subacute or chronic pulmonary reactions also have been reported in association with long-term nitrofurantoin administration.

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