Nitrofurantoin-induced pulmonary hemorrhage in a renal transplant recipient receiving immunosuppressive therapy: case report and review of the literature.

A 33-year-old woman received a cadaveric renal transplant for focal segmental glomerulosclerosis. Nitrofurantoin urinary prophylaxis was started on postoperative day 13 but coughing and mild hemoptysis began 2 days later. Diffuse infiltrates and worsening hemoptysis led to intubation and open lung biopsy. Clinical course, culture results and pathological evaluation excluded infectious etiologies and were consistent with a drug reaction. The case is described, and the literature on the nitrofurantoin pulmonary toxicity syndromes and pathophysiology is reviewed.