Drug induced interstitial lung disease

Abstract

With an increasing number of therapeutic drugs, the list of drugs that is responsible for severe pulmonary disease also grows. Many drugs have been associated with pulmonary complications of various types, including interstitial inflammation and fibrosis, bronchospasm, pulmonary edema, and pleural effusions. Drug-induced interstitial lung disease (DILD) can be caused by chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents. There are no distinct physiologic, radiographic or pathologic patterns of DILD, and the diagnosis is usually made when a patient with interstitial lung disease (ILD) is exposed to a medication known to result in lung disease. Other causes of ILD must be excluded. Treatment is avoidance of further exposure and systemic corticosteroids in patients with progressive or disabling disease.

Keywords: Lung; adverse drug reaction; diagnosis; drug-induced lung disease; mechanism of pulmonary toxicity; review.; treatment.

Fig. (1)

Characteristic histological patterns (Hematoxylin & Eosin staining in 100-200x magnification) in drug-induced interstitial lung disease, for example. (a) Hypersensitivity Pneumonia (a moderate chronic interstitial inflammation-the infiltrate consists of lymphocytes, plasma cells and multinucleated giant cells). (b) Organizing Pneumonia (airspaces are partially occupied by fibroblastic proliferations with collagen production). (c) Non specific interstitial Pneumonia (a homogeneous fibrotic broadening of the alveolar septa is seen with mild chronic inflammation, accompanied by hyperplasia of type II pneumocytes. (d) Usual interstitial Pneumonia (lung parenchyma with so-called honeycombing pattern-the lesion is characterized by cystic spaceswhich are surrounded by a dense fibrotic tissue.

Fig. (2)

Radiologic examples of drug induced interstitial lung disease, for example. (a) Bronchiolitis obliterans organizing Pneumonia. (b) Non specific interstitial Pneumonia. (c) Usual interstitial Pneumonia.