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  • • 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

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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.

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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.

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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.

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Table 33–1. Clinical Presentations of Drug-Induced Lung Disease.

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