<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452022000400051</article-id>
<article-id pub-id-type="doi">10.1159/000516940</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Concomitant Nitrofurantoin-Induced Autoimmune Hepatitis and Interstitial Lung Disease]]></article-title>
<article-title xml:lang="pt"><![CDATA[Hepatite autoimune e doença pulmonar intersticial induzidas por nitrofurantoína]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Matos]]></surname>
<given-names><![CDATA[Andreia Carvalho de]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Macedo]]></surname>
<given-names><![CDATA[Cristiane Pais]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mendes]]></surname>
<given-names><![CDATA[Patrícia Afonso]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cipriano]]></surname>
<given-names><![CDATA[Maria Augusta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Paiva]]></surname>
<given-names><![CDATA[Artur]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Simão]]></surname>
<given-names><![CDATA[Adélia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Coimbra Hospital and University Center Internal Medicine Department ]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,University of Coimbra Faculty of Medicine University Clinic of Internal Medicine]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Coimbra Hospital and University Center Pathology Department ]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Coimbra Hospital and University Center Flow Cytometry Unit ]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>08</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>08</month>
<year>2022</year>
</pub-date>
<volume>29</volume>
<numero>4</numero>
<fpage>51</fpage>
<lpage>57</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452022000400051&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452022000400051&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452022000400051&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Antibiotics are known to cause adverse reactions, but multiple organ involvement associated with nonspecific symptoms can lead to a delay in diagnosis. A definitive correlation between each toxin and its effects is difficult to establish due to concomitant potential toxins in the circulation. This article highlights an uncommon case of concomitant nitrofurantoin-induced autoimmune hepatitis and lung fibrosis that fulfills the definitive clinical criteria for diagnosis, presenting histological, imagiological, and immunological evidence of nitrofurantoin-induced toxicity. It occurred in a 68-year-old woman with extended nitrofurantoin intake for urinary tract infection prophylaxis who presented with progressive exercise dyspnea and jaundice. Similar published cases are also reviewed in this article.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo Os antibióticos são causas conhecidas de reações adversas, mas o envolvimento multiorgânico associado à sintomatologia inespecífica pode conduzir ao atraso diagnóstico. Devido às potenciais toxinas concomitantemente em circulação, é muitas vezes difícil estabelecer uma correlação definitiva entre cada toxina e os seus efeitos. Este artigo salienta um caso incomum de hepatite autoimune e fibrose pulmonar induzidas pela nitrofurantoína e que cumpre critérios definitivos de diagnóstico, apresentando-se dados histológicos, imagiológicos e imunológicos da toxicidade induzida pela nitrofurantoína. O caso ocorre numa mulher de 68 anos de idade, com toma prolongada de nitrofurantoína como profilaxia de infeção urinária, e que se apresenta com dispneia de esforço progressiva e icterícia. O artigo faz ainda uma revisão de casos semelhantes publicados.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Autoimmune hepatitis]]></kwd>
<kwd lng="en"><![CDATA[Nitrofurantoin toxicity]]></kwd>
<kwd lng="en"><![CDATA[Interstitial pulmonary disease]]></kwd>
<kwd lng="pt"><![CDATA[Hepatite autoimmune]]></kwd>
<kwd lng="pt"><![CDATA[Toxicidade a nitrofurantoína]]></kwd>
<kwd lng="pt"><![CDATA[Doença pulmonar intersticial]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Stricker]]></surname>
<given-names><![CDATA[BH]]></given-names>
</name>
<name>
<surname><![CDATA[Blok]]></surname>
<given-names><![CDATA[AP]]></given-names>
</name>
<name>
<surname><![CDATA[Claas]]></surname>
<given-names><![CDATA[FH]]></given-names>
</name>
<name>
<surname><![CDATA[Van Parys]]></surname>
<given-names><![CDATA[GE]]></given-names>
</name>
<name>
<surname><![CDATA[Desmet]]></surname>
<given-names><![CDATA[VJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hepatic injury associated with the use of nitrofurans: aclinicopathological study of 52 reported cases.]]></article-title>
<source><![CDATA[Hepatology]]></source>
<year>1988</year>
<month>Ma</month>
<day>y-</day>
<volume>8</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>599-606</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="">
<collab>European Medicines Agency, EudraVigilance</collab>
<source><![CDATA[Base de dados europeia de notificações dereações adversas medicamentosas suspeitas]]></source>
<year>2020</year>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="book">
<collab>LiverTox:Clinical and Research Information on Drug-Induced Liver Injury</collab>
<source><![CDATA[Bethesda,]]></source>
<year>2012</year>
<publisher-loc><![CDATA[MD ]]></publisher-loc>
<publisher-name><![CDATA[National Institute of Diabetes and Digestive and Kidney Diseases]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[deBoer]]></surname>
<given-names><![CDATA[YS]]></given-names>
</name>
<name>
<surname><![CDATA[Kosinski]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Urban]]></surname>
<given-names><![CDATA[TJ]]></given-names>
</name>
<name>
<surname><![CDATA[Zhao]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Long]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Chalasani]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Drug-Induced Liver Injury Network. Features of Autoimmune Hepatitis in PatientsWith Drug-induced Liver Injury.]]></article-title>
<source><![CDATA[Clin Gastroenterol Hepatol]]></source>
<year>2017</year>
<volume>15</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>103-12</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sherigar]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Fazio]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Zuang]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Arsura]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Autoimmune hepatitis induced by nitrofurantoin The importance of the autoantibodies for an early diagnosis of immune disease.Clin]]></article-title>
<source><![CDATA[Pract]]></source>
<year>2012</year>
<volume>2</volume>
<numero>4</numero>
<issue>4</issue>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Björnsson]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Talwalkar]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Treeprasertsuk]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Kamath]]></surname>
<given-names><![CDATA[PS]]></given-names>
</name>
<name>
<surname><![CDATA[Takahashi]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Sanderson]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Drug-induced autoimmune hepatitis: clinical characteristics and prognosis]]></article-title>
<source><![CDATA[Hepatology]]></source>
<year>2010</year>
<volume>51</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>2040-8</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="">
<collab>Autoridade Nacional do Medicamento eProdutos de Saúde.</collab>
<source><![CDATA[I.P, Sistema Nacional de Farmacovigilância. Relatórios deanálise periódica de dados]]></source>
<year>2020</year>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[ChalasaniN]]></surname>
<given-names><![CDATA[Bonkovsky HL]]></given-names>
</name>
<name>
<surname><![CDATA[Fontana R]]></surname>
<given-names><![CDATA[Lee W]]></given-names>
</name>
<name>
<surname><![CDATA[Stolz A]]></surname>
<given-names><![CDATA[Talwalkar J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[United StatesDrug Induced Liver Injury Network. Features and Outcomes of 899 Patients WithDrug-Induced Liver Injury: The DILIN Prospective Study]]></article-title>
<source><![CDATA[Gastroenterology]]></source>
<year>2015</year>
<volume>148</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>1340-52</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kelly]]></surname>
<given-names><![CDATA[BD]]></given-names>
</name>
<name>
<surname><![CDATA[Heneghan]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Bennani]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Connolly]]></surname>
<given-names><![CDATA[CE]]></given-names>
</name>
<name>
<surname><![CDATA[O'Gorman]]></surname>
<given-names><![CDATA[TA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nitrofurantoin-inducedhepatotoxicity mediated by CD8+ T cells]]></article-title>
<source><![CDATA[Am J Gastroenterol]]></source>
<year>1998</year>
<volume>93</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>819-21</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Matsuno]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Drug-induced interstitial lung disease mechanisms and best diagnostic approaches]]></article-title>
<source><![CDATA[Respir Res]]></source>
<year>2012</year>
<volume>13</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>39</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Suzuki]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Miwa]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Shirai]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ohba]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Murakami]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Fujita]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Drug lymphocyte stimulation test in the diagnosis of adversereactions to antituberculosis drugs]]></article-title>
<source><![CDATA[Chest]]></source>
<year>2008</year>
<volume>134</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>1027-32</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Whritenour]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Ko]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Zong]]></surname>
<given-names><![CDATA[Q]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Tartaro]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Schneider]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Development of a modified lymphocyte transformation testfor diagnosing drug-induced liver injury associated with an adaptive immuneresponse]]></article-title>
<source><![CDATA[J Immunotoxicol]]></source>
<year>2017</year>
<volume>14</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>31-8</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Purohit]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Kaur]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Che]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Warshafsky]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Dworkin]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nitrofurantoin-induced liver injury a case report]]></article-title>
<source><![CDATA[Am J Gastroenterol]]></source>
<year>2012</year>
<volume>107</volume>
<page-range>S407</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Milic]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Plavec]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Tufegdzic]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Tomic]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Sarac]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Loncarevic]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nitrofurantoin-inducedimmune-mediated lung and liver disease]]></article-title>
<source><![CDATA[Vojnosanit Pregl]]></source>
<year>2012</year>
<volume>69</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>536-40</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kiang]]></surname>
<given-names><![CDATA[TK]]></given-names>
</name>
<name>
<surname><![CDATA[Ford]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Yoshida]]></surname>
<given-names><![CDATA[EM]]></given-names>
</name>
<name>
<surname><![CDATA[Partovi]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nitrofurantoin-associated lung and liver toxicity leading to livertransplantation in a middle-aged patient]]></article-title>
<source><![CDATA[Can J Hosp Pharm]]></source>
<year>2011</year>
<volume>64</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>262-70</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peall]]></surname>
<given-names><![CDATA[AF]]></given-names>
</name>
<name>
<surname><![CDATA[Hodges]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Concomitant pulmonary and hepatictoxicity secondary to nitrofurantoin a case report]]></article-title>
<source><![CDATA[J Med Case Reports]]></source>
<year>2007</year>
<volume>1</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>59</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Reinhart]]></surname>
<given-names><![CDATA[HH]]></given-names>
</name>
<name>
<surname><![CDATA[Reinhart]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Korlipara]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Peleman]]></surname>
<given-names><![CDATA[R.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Combined nitrofurantoin toxicity to liver and lung]]></article-title>
<source><![CDATA[Gastroenterology]]></source>
<year>1992</year>
<volume>102</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>1396-9</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Schattner]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Von der Walde]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Kozak]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Sokolovskaya]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Knobler]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nitrofurantoin-induced immune-mediated lung andliver disease]]></article-title>
<source><![CDATA[Am J Med Sci]]></source>
<year>1999</year>
<volume>317</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>336-40</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
