High-resolution computed tomography patterns and immunopathogenetic findings in drug-induced pneumonitis

Abstract

We tried to determine whether high-resolution computed tomography (HRCT) patterns correlate with the immunopathogenetic findings and whether they could provide helpful information for predicting the outcomes in non-neoplastic drug-induced pneumonitis. The HRCT images were classified as most suggestive of pneumonitis, diffuse alveolar damage (DAD), non-specific interstitial pneumonia, organizing pneumonia (OP), hypersensitivity pneumonitis, and acute eosinophilic pneumonia (AEP) in 34 patients with non-neoplastic drug-induced pneumonitis. The patients were analyzed for the bronchoalveolar lavage (BAL) cell findings and for the circulating levels of interferon-inducible protein 10 (IP-10) and macrophage-derived chemokine (MDC), which were measured by an enzyme-linked immunosorbent assay. The cumulative dose of corticosteroids received by the patients and the day when they required supplemental oxygen were calculated as outcome markers. There were no differences in the circulating chemokine levels and the BAL cell profiles except for the eosinophil percentages among the HRCT patterns. Most of the cases with pulmonary eosinophilia belonged to the OP and AEP groups, and the circulating MDC levels correlated with BAL eosinophil percentages. We could not find any relationship between the BAL cell profiles or the chemokine levels and the outcome markers. In contrast, the HRCT patterns rather predicted the outcomes because larger cumulative dose of steroids and longer oxygen supply were required for the patients in the DAD and OP groups. In contrast, all patients with AEP recovered without steroid administration. The present study suggests that HRCT does not predict cellular pathophysiology but it may predict the corticosteroid use in non-neoplastic drug-induced pneumonitis.

Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients

“…In this group, 18 out of 26 patients had a chest CT scan, which revealed principally three patterns: nodules (5 mm), minimal ground glass opacities and smooth thickening of interlobular septa. These findings, among others, are described in the literature as typical of incipient pulmonary damage induced by cocaine use [20][21][22]. Taking these data into account, we believe that these cases of SPM were a result of the effects of cocaine; therefore, these should be considered secondary to the use of this drug and not spontaneous.…”

Soluble thrombomodulin in bronchoalveolar lavage fluid is an independent predictor of severe drug‐induced lung injury

“…17 However, in the present study, the percentages of neutrophils in BALF were correlated with the PaO 2 /FiO 2 ratio and were a predictor of respiratory failure in the univariate analysis. Takatani et al 18 demonstrated that elevated percentages of neutrophils in BALF were observed in some DLI patients. In addition, previous studies showed that activation and migration of neutrophils into the lung is one of the key events and correlated with the inflammatory cytokines in ARDS.…”

“…However, in the present study, the percentages of neutrophils in BALF were correlated with the PaO 2 /FiO 2 ratio and were a predictor of respiratory failure in the univariate analysis. Takatani et al . demonstrated that elevated percentages of neutrophils in BALF were observed in some DLI patients.…”

Pulmonary Drug Toxicity

“…Response to corticosteroid therapy in patients with drug-induced DAD is variable and may depend on the inciting drug, severity of the reaction, and promptness of the therapeutic intervention. 10 It is well known that DAD is often associated with antineoplastic drugs, amiodarone, and drugs of abuse. 7,10 Rarely it has been related to psychotropic drugs.…”

“…10 It is well known that DAD is often associated with antineoplastic drugs, amiodarone, and drugs of abuse. 7,10 Rarely it has been related to psychotropic drugs. 6,12,13 Several types of antidepressant have been implicated 6 : amitriptyline, 6 venlafaxina, 6,9 sertraline, 9,12 fluoxetine.…”