Nitrofurantoin-Induced Acute Liver Injury After Short-Term Use in an Elderly Patient: A Case Report

Background: Drug-induced liver injury (DILI) is a leading cause of acute liver dysfunction and acute liver failure in the United States. Nitrofurantoin is a well-recognized cause of DILI and is associated with both acute and chronic hepatitis-like syndromes. Case Presentation: A 77-year-old male with hypertension, hyperlipidemia, and chronic obstructive pulmonary disease developed severe hepatocellular injury after two days of nitrofurantoin therapy for a suspected urinary tract infection. He presented with generalized weakness, difficulty ambulating, and mild abdominal discomfort. Laboratory evaluation revealed markedly elevated transaminases. Nitrofurantoin was discontinued, and supportive care was initiated, resulting in rapid biochemical improvement. Conclusion: Nitrofurantoin-induced hepatotoxicity may occur even after short-term exposure. Early recognition and prompt discontinuation are essential to prevent progression. This case highlights the need for vigilance when prescribing nitrofurantoin in elderly patients