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drug-induced interstitial lung disease
Etiology:
1) chemotherapeutic agents & immunosuppressants
a) bleomycin
b) busulfan
c) nitrosourea
d) mitomycin C
e) cyclophosphamide
f) methotrexate
g) azathioprine
h) imatinib
2) amiodarone
3) antibiotics
a) nitrofurantoin
b) ethambutol
c) isoniazid
c) amphotericin B
d) sulfonamides
4) carbamazepine
5) antidepressants
a) fluoxetine
b) trazodone
6) drug-induced lupus erythematosus
a) hydralazine
b) procainamide
7) gold salts
8) D-penicillamine
9) methadone
10) oxygen
11) sulfasalazine
12) cromolyn
13) methysergide
14) hezamethonium
15) pentolinium
16) mecamylamine
17) diphenylhydantoin
18) GM-CSF
19) pituitary snuff
20) inhalation cocaine
21) intravenous talc
22) aspirated oil
Clinical manifestations:
1) exposure history with temporal cause-effect relationship
2) acute, subacute or chronic presentation
3) pneumonitis & fibrosis
- nitrofurantoin, bleomycin, methotrexate, amiodarone, gold salts, inhalation cocaine
5) non-cardiogenic pulmonary edema
6) fever, fatigue, cough
7) pleural effusion
8) pulmonary vasculitis
- hydralazine, procainamide
Laboratory: eosinophilia
Radiology:
- chest X-ray
1) nonspecific pulmonary inflammation & fibrosis
2) noncaseating granuloma in methotrexate pneumonitis
Management:
1) cessation of the offending agent
2) corticosteroids
3) prompt clinical response to 1 & 2
Related
radiation pneumonitis
General
interstitial lung disease; diffuse parenchymal lung disease (DPLS, ILD)
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 761
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14,
American College of Physicians, Philadelphia 1998, 2006