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Archives of Industrial Hygiene and Toxicology

The Journal of Institute for Medical Research and Occupational Health

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Nitrofurantoin-Induced Acute Liver Damage in Pregnancy

Alenka Akšamija1 / Gordana Horvat1 / Dubravko Habek1 / Damir Žalac1 / Eva Jendriš1

Department of Obstetrics and Gynaecology, Sveti Duh General Hospital Zagreb, Zagreb, Croatia1

Department of Obstetrics and Gynaecology, Polyclinic Sunce, Zagreb, Croatia2

This content is open access.

Citation Information: Archives of Industrial Hygiene and Toxicology. Volume 60, Issue 3, Pages 357–361, ISSN (Print) 0004-1254, DOI: https://doi.org/10.2478/10004-1254-60-2009-1940, September 2009

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Nitrofurantoin-Induced Acute Liver Damage in Pregnancy

This article presents a rare case of acute toxic hepatitis in thirty-one-year old primigravida. In the 36th week of gestation, the patient was introduced nitrofurantoin 100 mg a day due to symptoms of dysuria and enterococcus isolated from urine culture. After induced delivery at term because of hypertension, repeated laboratory findings showed increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and negative hepatitis C and B markers. The patient was subicteric at the time. Coagulation and complete blood count values were within the normal range. Nitrofurantoin therapy was discontinued. Abdominal ultrasound was normal with the exception of a slight hepatomegaly without any lesions, focal or diffuse. Given that discontinuation of nitrofurantoin and introduction of methylprednisolon therapy significantly lowered liver enzyme levels, restoring most of them to normal, we concluded that this was probably the case of toxic liver damage caused by nitrofurantoin.

Akutno oštećenje jetre uzrokovano primjenom nitrofurantoina u trudnoći

Autori prikazuju rijedak slučaj akutnog oštećenja jetre - akutni toksični hepatitis u 31-godišnje primigravide. U 36. tjednu trudnoće zbog dizuričnih smetnji i dokazanog enterokoka u urinokulturi ordiniran je nitrofurantoin 1×100 mg. Nakon terminski induciranoga poroda zbog hipertenzije, ponovljene laboratorijske pretrage upućuju na značajno povišenje vrijednosti jetrenih enzima uz negativne markere na C i B-hepatitis te subikterus. Koagulogram i crvena krvna slika bili su uredni. Nitrofurantoin se isključuje iz terapije. Abdominalni ultrazvuk upućuje na hepatomegaliju bez fokalnih ili difuznih oštećenja.

Nakon isključenja nitrofurantoina iz terapije uz metilprednizolon, vrijednosti jetrenih enzima se normaliziraju, što potvrđuje slučaj toksičnog oštećenja jetre uzrokovanog nitrofurantoinom.

Keywords: antibiotic; hepatotoxicity; pregnant woman; therapy

Keywords: antibiotik; gravidne žene; hepatotoksičnost; terapija

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