First suspected case of nifuratel-induced interstitial lung disease with interlobular septal thickening

Abstract Background Drug-induced interstitial lung disease (DI-ILD) is a rare but important adverse reaction, with nitrofurantoin being a well-known cause among nitrofuran derivatives. Nifuratel, another nitrofuran sharing the same core structure, has not been previously associated with ILD. Case presentation A 43-year-old woman developed fever and progressive dyspnea four days after initiating oral nifuratel and nifuratel-nystatin vaginal suppositories for vulvovaginal candidiasis. Empirical antibiotics yielded no improvement. High-resolution computed tomography (HRCT) revealed bilateral upper lobe interlobular septal thickening with subpleural predilection. Extensive infectious, rheumatologic, and cardiac workups were negative. Nifuratel was discontinued and systemic corticosteroids initiated, with rapid symptom resolution and near-complete radiographic resolution on hospital day 4. Conclusions To our knowledge, this is the first suspected case of nifuratel-induced interstitial lung disease. This case extends a potential nitrofuran “class effect” to nifuratel and highlights interlobular septal thickening as a distinctive imaging pattern that should prompt consideration of DI-ILD in the appropriate clinical context.