Chronic Active Hepatitis and Severe Hepatic Necrosis Associated with Nitrofurantoin

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Abstract
Nitrofurantoin was associated with an acute hepatocellular and cholestatic injury, but only rarely with a lesion resembling chronic active hepatitis. Death from nitrofurantoin hepatotoxicity after long-term therapy was not described. Cases [5] of chronic active hepatitis, including 2 deaths, associated with nitrofurantoin and previously reported cases are discussed. All of the 20 patients were women and had taken the drug from 4 wk to 11 yr. Most patients had a low serum albumin and an elevated gamma globulin; antinuclear antibody was positive in 12 patients. Patients [18] improved clinically and biochemically when the drug was withdrawn. Cirrhosis occurred in 4 patients. Both of the patients who died had taken the drug for more than 1 yr and had a clinical course of progressive hepatic failure. Severe hepatic necrosis was noted at autopsy in both patients.