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Neurologic examination revealed preserved muscle strength and tendon reflexes in all extremities.

Treatment with antihistamine and leukotriene blockers had no effect on her symptoms.

A trial of high dose prednisolone acetate, 60 mg/d relieved her symptoms, but they recurred on prednisolone tapering. The results from extensive investigations including autoimmune and connective tissue serology were unremarkable. Her symptoms persisted despite discontinuation of nitrofurantoin. She developed generalized livedo reticularis and photosensitivity across her face and extremities. Four weeks into the therapy, she reported generalized dysesthesias with prickly heat and sunburnlike sensations, which were pronounced in the thighs, shoulders, and neck. Two years prior, she had been treated with prophylactic nitrofurantoin, 100 mg daily, for urinary retention following the repair of a bladder prolapse. Her medical history was significant only for interstitial cystitis. Skin biopsy appears to be helpful in confirming the diagnosis in these patients.Ī 59-year-old woman had a 2-year history of generalized patchy dysesthesias. Skin biopsies revealed distinctive morphologic changes with clustered terminal nerve swellings without evidence of nerve fiber degeneration.Ĭonclusions These distinct morphologic changes associated with nitrofurantoin have not been previously reported to our knowledge. Results from nerve conduction studies were normal. Results The neuropathy was neither dose dependent nor associated with impaired renal function. Main Outcome Measures Slow or incomplete recovery and possibly irreversible damage. Patients A 59-year-old woman with disabling generalized dysesthesia and a 53-year-old woman with progressive burning pain in the perineum and extremities. Setting Clinical evaluation and skin biopsies were performed at a tertiary teaching hospital in Baltimore, Maryland. Objective To investigate the role of skin biopsy in nitrofurantoin peripheral neuropathy.ĭesign We describe the clinical features and skin biopsies of 2 cases of non–length-dependent small-fiber neuropathy/ganglionopathy attributable to nitrofurantoin. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.