Pulmonary fibrosis associated with psychotropic drug therapy: a case report

Abstract

Introduction: Sertraline and Risperidone are commonly used psychotropic drugs. Sertraline has previously been associated with eosinopilic pneumonia. Neither drug is recognised as a cause of diffuse fibrotic lung disease. Our report represents the first such case.

Case presentation: We describe the case of a 33 year old Asian male with chronic schizophrenia who had been treated for three years with sertraline and risperidone. He presented to hospital in respiratory failure following a six month history of progressive breathlessness. High resolution CT scan demonstrated diffuse pulmonary fibrosis admixed with patchy areas of consolidation. Because the aetiology of this man's diffuse parenchymal lung disease remained unclear a surgical lung biopsy was undertaken. Histological assessment disclosed widespread fibrosis with marked eosinophillic infiltration and associated organising pneumonia - features all highly suggestive of drug induced lung disease. Following withdrawal of both sertraline and risperidone and initiation of corticosteroid therapy the patient's respiratory failure resolved and three years later he remains well albeit limited by breathlessness on heavy exertion.

Conclusion: Drug induced lung disease can be rapidly progressive and if drug exposure continues may result in respiratory failure and death. Prompt recognition is critical as drug withdrawal may result in marked resolution of disease. This case highlights sertraline and risperidone as drugs that may, in susceptible individuals, cause diffuse pulmonary fibrosis.

Figure 1

High resolution thoracic CT at time of diagnosis. High resolution CT sections at the level of a) the hila and b) the lung bases demonstrate widespread, bilateral ground glass change, multifocal patches of consolidation and evidence of fibrosis with fine reticulation and traction bronchiectasis.

Figure 2

Photomicrographs of left sided surgical lung biopsy. 2a) The lung shows a histological pattern of fibrotic NSIP with diffuse established interstitial fibrosis associated with moderate chronic inflammation (×20 magnification). 2b) The lung at high power, shows focal organising pneumonia within a respiratory bronchiole with abundant eosinophils in the adjacent interstitium.

Figure 3

High resolution thoracic CT three years after diagnosis. High resolution CT sections at the level of a) the hilae and b) the lung bases demonstrate resolution of the previously noted consolidation and a reduction in ground glass attenuation. However evidence of fibrosis persists with bilateral reticular change and traction bronchiectasis. The dome of the right hemidiaphragm is visible in the image of the lung bases (b).