CTICasesNitrofurantoin-Induced Organizing Pneumonia
Imaging findings
Chest CT demonstrates bilateral, patchy areas of consolidation and subpleural ground-glass opacities, displaying a distinct perilobular pattern of thickening along the interlobular septa at both lung bases. There is associated bronchial dilation within the areas of consolidation. Follow-up CT performed four to six months after discontinuing the offending medication reveals dramatic, near-complete resolution of the consolidative opacities, perilobular thickening, and bronchial dilation without the use of systemic corticosteroids.
Key takeaways
Nitrofurantoin is a well-known cause of drug-induced interstitial lung disease, which can manifest as an acute hypersensitivity reaction or a chronic, progressive fibrosing process such as non-specific interstitial pneumonia (NSIP) or organizing pneumonia. The presence of a perilobular pattern of consolidation on CT is highly suggestive of organizing pneumonia and, in the context of long-term nitrofurantoin use, should prompt immediate drug cessation. Furthermore, bronchial dilation in areas of acute or subacute organizing pneumonia represents reversible airway stretching rather than true, irreversible traction bronchiectasis, emphasizing the need for caution before diagnosing permanent fibrosis.
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