Acute onset nitrofurantoin-induced autoimmune hepatitis after urinary tract infection treatment

Abstract

Key clinical message: This case signifies the importance of recognizing DIAIH within the context of antibiotic therapy, especially in older adults and even shortly after common drug exposures for treating UTI.

Abstract: Various drugs can induce immune-mediated liver damage and in rare instances may lead to autoimmune hepatitis. Here we report an 84-year-old woman who developed autoimmune hepatitis less than 3 weeks after treatment for urinary tract infection with the antibiotic nitrofurantoin. She presented with jaundice, right upper quadrant abdominal pain, nausea, and vomiting. In the absence of a history of an autoimmune disorder or elevated liver enzymes in the past; elevated liver enzymes after a short course of Nitrofurantoin and the presence of smooth muscle antibodies strongly suggested autoimmune hepatitis, which was confirmed through biopsy sample analysis. The patient scored 7 points on the Naranjo adverse reaction probability scale. The patient's rapid recovery within 1 month of prednisone therapy supports the association of liver damage with nitrofurantoin use.

Keywords: Naranjo adverse reaction; drug‐induced autoimmune hepatitis; elevated liver enzymes; nitrofurantoin toxicity.

FIGURE 1

Hepatitis with moderate lymphoplasmacytic necroinflammatory activity.

FIGURE 2

Trichrome special stain reveals focal portal fibrosis present.

FIGURE 3

Acute hepatitis with moderate necroinflammatory activity.