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Nitrofurantoin lung disease — SCE Respiratory MCQ

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HardILDNitrofurantoin lung diseaseSCE Respiratory

A 70-year-old woman has taken nitrofurantoin prophylaxis for recurrent urinary infection for 3 years. She now has cough, exertional dyspnoea and bibasal crackles. HRCT shows basal reticulation and ground-glass opacities; eosinophils are normal and autoimmune screen is negative. What is the most likely underlying cause?

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Correct answer: D — Chronic nitrofurantoin-induced lung disease

The best answer is “Chronic nitrofurantoin-induced lung disease”. The clinical pattern, physiology and imaging described are most consistent with Chronic nitrofurantoin-induced lung disease. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Occult pulmonary embolism, after specialist assessment”, “Primary ciliary dyskinesia, with clinical reassessment”, “Aspirin-exacerbated respiratory disease”, “Latent tuberculosis infection, after safety review”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society clinical statement on pulmonary eosinophilia: https://thorax.bmj.com/content/76/Suppl_1/s1