This condition may occur during treatment or weeks to months after treatment has stopped. This medication may rarely cause a severe intestinal condition due to a bacteria called C. Get medical help right away if you develop symptoms of lung problems, including: persistent cough, chest pain, shortness of breath/ trouble breathing, joint/ muscle pain, bluish/purplish skin. Lung problems may occur within the first month of treatment or after long-term use of nitrofurantoin (generally for 6 months or longer). This medication may rarely cause very serious (possibly fatal) lung problems.
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Get medical help right away if you have any very serious side effects, including: numbness/tingling of the hands/feet, unusual muscle weakness. Tell your doctor right away if you have any serious side effects, including: eye pain, vision changes, mental/mood changes, persistent/severe headaches, new signs of infection (such as fever, persistent sore throat), easy bruising/bleeding. Get medical help right away if you notice dark urine along with any of the following symptoms: persistent nausea/ vomiting, stomach/ abdominal pain, yellowing eyes/ skin, tiredness, fast/pounding heartbeat. However, dark brown urine can also be a sign of rare side effects ( liver problems or anemia). This is usually a harmless, temporary effect and will disappear when the medication is stopped. This medication may cause your urine to turn dark yellow or brown in color. Many people using this medication do not have serious side effects. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
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Since Nitrofurantoin can cause sometimes severe liver damage, the indication for its use should be evidence-based, and signs/symptoms of liver injury should lead to prompt cessation of therapy.Nausea, headache may occur. She had been treated with Nitrofurantoin in past infections as well. Additionally, our patient was seen to have features of drug-induced autoimmune hepatitis with her ANA elevation suggesting a component of chronic liver injury. Her workup was negative and the only identifiable etiology of her acute liver injury was her nitrofurantoin use. In our case, the patient experienced marked elevations in her liver enzymes that resolved with only supportive care. DISCUSSION:ĭILI can be a difficult diagnosis to make because it is a diagnosis of exclusion. The patient was treated supportively and had a gradual decrease in her liver enzymes over the course of three days. Secondary workup for liver injury was largely negative except an ANA titer of 1:320. CT Abdomen and Pelvis showed hepatic steatosis but no acute processes. On labs, she was found to have elevated alkaline phosphatase of 200 U/L, ALT 1014 U/L, AST 2011 U/L, Total Bilirubin 1.0 mg/dL, Lipase 59 U/L, negative alcohol level, negative acetaminophen level, and negative viral hepatitis panel. On presentation, the patient's vitals were found to be: 98.5F, HR 107, 156/74, and saturating well on room air.
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Two weeks later, the patient began to develop worsening abdominal pain that was accompanied by diarrhea and subjective fevers and chills. Urinary symptoms resolved after antibiotic completion. Prior to symptoms onset, she had developed burning and odor in her urine and was treated with nitrofurantoin for 14 days. The patient is a 56 year old female with a past medical history of recurrent urinary tract infections including ESBL who presented with abdominal pain, diarrhea, and nausea for one month. This case demonstrates the need to have high suspicion for DILI when patients present with elevated liver enzymes with recent use of nitrofurantoin. Chronic liver injury typically presents months or years after use of nitrofurantoin and can also present as an autoimmune type reaction. Acute liver injury occurs within a few weeks of nitrofurantoin use and resolves quickly after discontinuation. Nitrofurantoin can cause acute or chronic liver injury. It is also one of the most common medications known to cause drug-induced liver injury (DILI). Nitrofurantoin is one of the most commonly prescribed antibiotics for urinary tract infections.