Sherigar Jagannath M, Fazio Richard, Zuang Minsheng, Arsura Edward
Department of Internal Medicine, Northwest Mississippi Regional Medical Center, Clarksdale, MS;
Department of Gastroenterology.
Clin Pract. 2012 Oct 17;2(4):e83. doi: 10.4081/cp.2012.e83. eCollection 2012 Oct 12.
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.
自1953年以来，呋喃妥因一直作为预防复发性尿路感染的有效药物使用。它与多种药物不良反应相关。慢性活动性肝炎的观察日益增多，已有多例病例报告并出现死亡情况。我们报告一例呋喃妥因诱发的慢性活动性肝炎病例，并简要回顾英文文献中报道的57例类似病例的血清学及临床病理特征。抗核抗体、抗平滑肌抗体、免疫球蛋白升高及病理特征的持续存在提示存在免疫机制。如果及时停药，大多数病例有可能完全康复。如果停药后仍无改善，类固醇可能在治疗中发挥作用。我们建议所有接受长期呋喃妥因治疗的患者每三个月进行抗核抗体、抗平滑肌抗体、血清免疫球蛋白及肝功能检查随访。
