Autoimmune hepatitis induced by nitrofurantoin. The importance of the autoantibodies for an early diagnosis of immune disease

Abstract

Nitrofurantoin has been in use since 1953 as an effective agent for the prevention of recurrent urinary tract infection. It is associated with a wide range of adverse drug reactions. Chronic active hepatitis has increasingly been observed and many cases have been reported with case fatalities. We present a case of nitrofurantoin induced chronic active hepatitis and briefly review the serology and clinico pathological features of 57 similar cases reported in English literature. The consistent presence of antinuclear antibody, anti smooth muscle antibody, elevated immunoglobulin and pathological feature suggests an immunologic mechanism. Complete recovery is possible in most cases if medication is discontinued in time. Steroids may play a role in management if no improvement occurs despite discontinuation of medication. We suggest all patients who are on prolonged nitrofurantoin therapy be followed up with anti nuclear antibody, anti smooth muscle antibody, serum immunoglobulin and hepatic panel every three months.

Keywords: anti nuclear antibody; anti smooth muscle antibody; chronic active hepatitis; hepatotoxicity.; nitrofurantoin.

Figure 1

Moderate chronic inflammatory cell infiltration was seen in mildly expanded portal tracts with interface inflammation. Inflammation (accentuated periportally) also seen in lobules with point necrosis and hepatocyte dropout.

Figure 2

High magnification demonstrates many plasma cells (red arrows) among infiltrating inflammatory cells.