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RESEARCH PRODUCT

Drug-induced infiltrative lung disease

subject

description

International audience; Because the lung manifestations of drugs may be highly variable, a high index of suspicion is required. Both current and past drug intake should be carefully evaluated in any patient with infiltrative lung disease. Drug-induced infiltrative lung disease may manifest as variable clinical radiological patterns, including subacute or chronic interstitial pneumonia, pulmonary fibrosis, eosinophilic pneumonia (presenting as Loffler syndrome, or chronic or acute eosinophilic pneumonia), organising pneumonia, diffuse alveolar haemorrhage, acute respiratory distress syndrome, pulmonary oedema, lipoid pneumonia, alveolar proteinosis or sarcoidosis. A variety of drugs have been incriminated, including those used in cardiovascular diseases (amiodarone, statins and angiotensin-converting enzyme inhibitors), antibiotics (especially minocycline and nitrofurantoin), most anticancer drugs and especially chemotherapy, treatment of rheumatoid arthritis (nonsteroidal anti-inflammatory agents, methotrexate, D-penicillamine and tumour necrosis factor-a inhibitors), as well as more recent drugs (interferon, interleukin-2, rituximab, imatinib, dasatinib, gefitinib and sirolimus). Although some risk factors have been identified, the precise mechanisms of drug-induced infiltrative lung disease are largely unknown. The history of exposure to the drug, the timing of drug exposure, the clinical and imaging pattern, the possible improvement following drug discontinuation and the exclusion of other causes of infiltrative lung disease all contribute to the diagnosis and assessment of causality. Although the recurrence of manifestations after patient rechallenge with the drug is considered the best imputability criterion, rechallenge may be dangerous and is discouraged. Web-based updated lists of drugs causing lung adverse events (www.pneumotox.com) represent a useful tool when considering possible causative drugs, and drug causality should be carefully evaluated both in published cases and in clinical practice. Withdrawal of the offending drug and administration of corticosteroids when required may reverse a potentially life-threatening situation.