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Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin

Nitrofurantoin is a commonly used treatment for urinary tract infections with a risk for pulmonary toxicity. We report a case of a 48-year-old woman on a prophylactic regimen of nitrofurantoin who exhibited classic signs of bacterial sepsis including elevated procalcitonin (PCL) and C-reactive prote...

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Autores principales: Khan, Tahir Muhammad Abdullah, Ansari, Yusra, Siddiqui, Abdul Hasan, Matthew, Hall, Siddiqui, Faraz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819057/
https://www.ncbi.nlm.nih.gov/pubmed/31687292
http://dx.doi.org/10.7759/cureus.5516
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author Khan, Tahir Muhammad Abdullah
Ansari, Yusra
Siddiqui, Abdul Hasan
Matthew, Hall
Siddiqui, Faraz
author_facet Khan, Tahir Muhammad Abdullah
Ansari, Yusra
Siddiqui, Abdul Hasan
Matthew, Hall
Siddiqui, Faraz
author_sort Khan, Tahir Muhammad Abdullah
collection PubMed
description Nitrofurantoin is a commonly used treatment for urinary tract infections with a risk for pulmonary toxicity. We report a case of a 48-year-old woman on a prophylactic regimen of nitrofurantoin who exhibited classic signs of bacterial sepsis including elevated procalcitonin (PCL) and C-reactive protein (CRP) levels two days post-nephrolithotripsy. The microbial analysis did not reveal an infectious cause for the initial symptoms and, subsequently, the patient developed a dry cough, fever, chills, and transient hypoxemia requiring supplemental oxygen. Pulmonary imaging revealed significant abnormal features inconsistent with the patient’s symptoms which indicated an inflammatory/immune reaction to nitrofurantoin. Treatment discontinuation improved the patient’s symptoms and reduced PCL and CRP levels to within normal limits. A high index of suspicion for nitrofurantoin-associated pulmonary toxicity is warranted for patients on a regimen of nitrofurantoin who exhibit severe pulmonary symptoms and elevated PCL and CRP levels with no corresponding infection.
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spelling pubmed-68190572019-11-04 Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin Khan, Tahir Muhammad Abdullah Ansari, Yusra Siddiqui, Abdul Hasan Matthew, Hall Siddiqui, Faraz Cureus Infectious Disease Nitrofurantoin is a commonly used treatment for urinary tract infections with a risk for pulmonary toxicity. We report a case of a 48-year-old woman on a prophylactic regimen of nitrofurantoin who exhibited classic signs of bacterial sepsis including elevated procalcitonin (PCL) and C-reactive protein (CRP) levels two days post-nephrolithotripsy. The microbial analysis did not reveal an infectious cause for the initial symptoms and, subsequently, the patient developed a dry cough, fever, chills, and transient hypoxemia requiring supplemental oxygen. Pulmonary imaging revealed significant abnormal features inconsistent with the patient’s symptoms which indicated an inflammatory/immune reaction to nitrofurantoin. Treatment discontinuation improved the patient’s symptoms and reduced PCL and CRP levels to within normal limits. A high index of suspicion for nitrofurantoin-associated pulmonary toxicity is warranted for patients on a regimen of nitrofurantoin who exhibit severe pulmonary symptoms and elevated PCL and CRP levels with no corresponding infection. Cureus 2019-08-29 /pmc/articles/PMC6819057/ /pubmed/31687292 http://dx.doi.org/10.7759/cureus.5516 Text en Copyright © 2019, Khan et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Infectious Disease
Khan, Tahir Muhammad Abdullah
Ansari, Yusra
Siddiqui, Abdul Hasan
Matthew, Hall
Siddiqui, Faraz
Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin
title Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin
title_full Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin
title_fullStr Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin
title_full_unstemmed Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin
title_short Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin
title_sort nitrofurantoin-associated acute pulmonary toxicity mimicking severe sepsis with significantly elevated procalcitonin
topic Infectious Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819057/
https://www.ncbi.nlm.nih.gov/pubmed/31687292
http://dx.doi.org/10.7759/cureus.5516
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