- • Drug-induced lung disease has a number of different
and distinct clinical manifestations.
- • Drug-induced lung disease is a diagnosis of exclusion.
- • Diagnosis depends upon identifying the exposure
and requires a thorough drug history.
- • Lung biopsy may be supportive by demonstrating
an appropriate pattern of lung injury but is not diagnostic
Drug-induced lung disease may present with a variety of manifestations
and has been associated with over 100 separate agents. However,
if the agents to which a patient has been exposed and the interval
since exposure are known, the potential pulmonary complications
from that exposure will be fairly limited. In addition, there are
stereotypical patterns of injury that suggest the possibility of
drug-induced lung injury.
The diagnosis of drug-induced lung disease is usually one of
exclusion as there is no single test that can confirm or refute
this diagnosis. Depending upon the clinical manifestation of toxicity, signs
and symptoms will vary and may mimic common entities such as pneumonia,
heart failure, collagen-vascular disease, or cancer. Likewise, chest
imaging rarely specifically suggests drug toxicity. Diagnosis usually
requires ruling out other causes of the patient’s disease
and identifying an appropriate exposure, appropriate time interval
between exposure and disease, and appropriate clinical manifestation
for a suspect drug.
Establishing exposure requires a thorough medication history
that reviews not only current medications but all drugs that the
patient has ever taken, including over-the-counter agents. This
history should also include herbal and alternative medications,
nutritional supplements, and illicit drug use. Drug-induced lung
disease may occur within minutes of taking a medication or many years
after taking a drug. Specific prompts and questioning are frequently
necessary to clarify issues such as trade names, medications received
during hospitalizations, and nondrug therapies such as radiation
or supplemental oxygen. A specific search for the use of more common
offenders such as amiodarone, nitrofurantoin, or methotrexate is
useful when patients present with a clinical picture suggestive
of drug-induced lung disease.
Clinical Presentations of Drug-Induced Lung Disease. |Favorite Table|Download (.pdf)
Clinical Presentations of Drug-Induced Lung Disease.
|Bronchiolitis obliterans with organizing
|Nonsteroidal antiinflammatory drugs|
|Eosinophilic lung disease|
|Drugs associated with drug-induced lupus|
|Tricyclic antidepressant overdose|
|Nitrosoureas (BCNU, CCNU, methyl-CCNU)|
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