Drug-induced lung disease
Updates to Article Attributes
Drug-induced lung disease can result from a number of agents and may have a myriad of presentations, ranging from an adult respiratory distress syndrome type picture to established pulmonary fibrosis.
Due to this, it can be extremely difficult to pinpoint the offending agent on imaging appearances alone and correlation with the medical history is mandatory.
Pathology
Aetiology
Chemotherapy agents
These can give several patterns of disease which include 1,5 :
- interstitial fibrosis: typically NSIP 5 pattern
- hypersensitivity pneumonitis pattern
- adult respiratory distress syndrome / diffuse alveolar damage pattern
- bronchiolitis obliterans organising pneumonia type pattern
- pulmonary haemorrhage
Example agents include:
- bleomycin lung toxicity
- busulfan lung toxicity
- carmustine lung toxicity
- chlorambucil lung toxicity
- cyclophosphamide toxicity
- docetaxel induced interstitial pneumonitis 11,12
- gemcitabine lung toxicity 14
- melphalan associated pulmonary toxicity
- methotrexate lung disease
- paclitaxel lung toxicity
- pemtrexed - pemtrexed induced pneumonitis
- thalidomide-induced interstitial pneumonitis
Immunosuppressive agents
- sirolimus: sirolimus-associated pulmonary toxicity 9
- leflunomide (arava): leflunomide-induced acute interstitial pneumonia 10
- sulfasalazine lung toxicity
Immunotherapy agents
Immune checkpoint inhibitor therapy-related pneumonitis / immune-mediated pneumonitis usually happens between 8 to 14 weeks after the start of treatment 13. Examples of agents include:
- nivolumab
- pembrolizumab
- ipilimumab
Cardiovascular agents
- amiodarone lung toxicity
Antibiotic agents
Can also give similar patterns to that of chemotherapeutic agents. Examples include:
Anti-inflammatory agents
Recreational drugs
- IV methylphenidate (Ritalin lung): panacinar emphysema
- IV heroin 6: pulmonary oedema, pulmonary haemorrhage, eosinophilic pneumonia
- IV cocaine: pulmonary oedema
- vaping associated lung disease
Anticonvulsants
- phenytoin: eosinophilic pneumonia 4
Others
Accidental inhalation or ingestion of various agents:
- herbicides
- paraquat (N,N′-dimethyl-4,4′-bipyridinium dichloride): paraquat-induced lung disease
-<li><a title="paclitaxel lung toxicity" href="/articles/paclitaxel-lung-toxicity">paclitaxel lung toxicity</a></li>- +<li><a href="/articles/paclitaxel-lung-toxicity">paclitaxel lung toxicity</a></li>
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