CTICasesNitrofurantoin Lung (Drug-induced Pulmonary Fibrosis)
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Imaging findings
Chest radiograph showed reticulation throughout the lungs, massive predominant. HRCT revealed peripheral and central pulmonary fibrosis with a perilobular preponderance. Honeycombing was present in the lung bases, especially the right lower lobe. Peribronchial fibrosis and traction bronchiectasis were also noted.
Key takeaways
The perilobular pattern of fibrosis suggests a cause of pulmonary fibrosis other than idiopathic pulmonary fibrosis (IPF). Drug history is crucial, as nitrofurantoin can cause pulmonary fibrosis, often with a delayed presentation. The case highlights the importance of re-interviewing patients for specific medication exposures if imaging findings are atypical for common interstitial lung diseases. There is discussion about the overlap between fibrosing organizing pneumonia and NSIP, as this pattern can evolve similarly.
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