The Spectrum of Drug-Induced Interstitial Lung Disease

Ratwani, Ankush; Gupta, Bhavana; Stephenson, Brian W.; Mani, Haresh; Brown, Anne

doi:10.1007/s13665-019-00233-y

Cited by 5 publications

(5 citation statements)

References 41 publications

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“…Other clinical syndromes of drug-induced alveolar and interstitial conditions include acute respiratory distress syndrome (ARDS) or acute lung injury (ALI) which manifests histologically as diffuse alveolar damage (DAD), as well as eosinophilic pneumonia (EP), hypersensitivity pneumonia (HP), pulmonary edema, pulmonary alveolar proteinosis, and diffuse alveolar haemorrhage. DLI may also present as bronchospasm, constrictive bronchiolitis obliterans, vasculitis, pulmonary hypertension, pulmonary veno-occlusive disease and pleuritis ( 28 , 30 , 32 , 33 ).…”

Section: Discussionmentioning

confidence: 99%

“…The cornerstone of management of patients with drug hypersensitivity reaction (DHR) or DLI involves discontinuation of the inciting drug followed by supportive care ( 31 , 36 ). Adjunctive treatment with corticosteroids may be considered to suppress the inflammatory process ( 31 , 37 ) although its efficacy varies widely ( 33 , 38 ). Certain types of DLIs including NSIP, OP, HP and EP have favorable response to corticosteroids, ( 30 , 33 , 38 ), while other cases such as DAD-type or advanced fibrosis are unlikely to respond to corticosteroids ( 30 , 33 ).…”

Section: Discussionmentioning

confidence: 99%

“…Adjunctive treatment with corticosteroids may be considered to suppress the inflammatory process ( 31 , 37 ) although its efficacy varies widely ( 33 , 38 ). Certain types of DLIs including NSIP, OP, HP and EP have favorable response to corticosteroids, ( 30 , 33 , 38 ), while other cases such as DAD-type or advanced fibrosis are unlikely to respond to corticosteroids ( 30 , 33 ). For both drug-induced and non-drug-induced ARDS, the role of steroids remains controversial ( 32 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

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Trimethoprim-sulfamethoxazole-induced lung injury: a case report

Huang,

Kam,

Tan

et al. 2023

Transl Pediatr

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Background Trimethoprim-sulfamethoxazole (TMP-SMX) is a commonly used antibiotic. While cutaneous adverse drug reactions associated with TMP-SMX are commonly recognized, lung toxicity induced by TMP-SMX is an unusual condition, with scattered reports of hypersensitivity pneumonitis, acute fibrinous organizing pneumonia, interstitial lung disease and acute respiratory distress syndrome. Reports of TMP-SMX-associated drug-induced lung injury (DLI) are rare in the pediatric population and its pathogenesis is not well understood. Diagnosis of DLI remains a challenge, given the wide range of clinical presentations that overlap with other conditions and the lack of diagnostic tests. In this report, we describe a case of TMP-SMX-induced lung injury in an eight-year-old child. Case Description An eight-year-old girl presented in respiratory failure with acute symptoms of shortness of breath, fever, maculopapular rash and vomiting. This was associated with pneumonitis, pneumothorax, pneumomediastinum and subcutaneous emphysema on imaging. She had been on 25 days of TMP-SMX for treatment of Group D Salmonella bacteremia and osteomyelitis that was diagnosed prior to this current presentation. TMP-SMX was discontinued on admission due to concerns of possible drug reaction. Extensive infective, autoimmune and immunologic workup did not reveal the cause of the respiratory failure. Considering the absence of an alternative explanation for her clinical presentation and similarities in clinical courses to other reported cases, she was eventually diagnosed with TMP-SMX-associated DLI. She received a course of corticosteroids with subsequent clinical improvement and was weaned off home oxygen therapy a few months after her discharge from the hospital. Conclusions Diagnosis of DLI can be challenging. The early identification of DLI and discontinuation of culprit drug is essential in its management. Further understanding of the underlying pathophysiology and risk factors for TMP-SMX-associated DLI is required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trimethoprim-sulfamethoxazole-induced lung injury: a case report

Huang,

Kam,

Tan

et al. 2023

Transl Pediatr

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“…Before the start of any anticancer therapy, physicians should carefully evaluate the risk for DIILD ( Supplementary Table S2 , available at https://doi.org/10.1016/j.esmoop.2022.100404 ), 4 although risk factors vary among studies (which have mainly been retrospective) and anticancer drugs. 4 , 24 , 25 …”

Section: Risk Factorsmentioning

confidence: 99%

Drug-induced interstitial lung disease during cancer therapies: expert opinion on diagnosis and treatment

et al. 2022

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“…In these cases, it is not the offending antigen per se, but the local inflammatory response that can serve as a trigger for the fibrogenic response [ 52 ]. Continuous exposure to the offending agent has been associated with disease progression in HP, pneumoconiosis, and drug-induced ILD [ 17 , 18 , 19 , 20 , 21 , 22 ]. No randomized controlled trials of exposure avoidance have been performed, but removal of the offending exposure is very likely to be beneficial for all patients with pulmonary fibrosis related to specific exposures.…”

Section: Application Of the ‘Treatable Traits’ Concept In Fibrotic Ildmentioning

confidence: 99%

Towards Treatable Traits for Pulmonary Fibrosis

Hoffman

Grutters

2022

JPM

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Interstitial lung diseases (ILD) are a heterogeneous group of disorders, of which many have the potential to lead to progressive pulmonary fibrosis. A distinction is usually made between primarily inflammatory ILD and primarily fibrotic ILD. As recent studies show that anti-fibrotic drugs can be beneficial in patients with primarily inflammatory ILD that is characterized by progressive pulmonary fibrosis, treatment decisions have become more complicated. In this perspective, we propose that the ‘treatable trait’ concept, which is based on the recognition of relevant exposures, various treatable phenotypes (disease manifestations) or endotypes (shared molecular mechanisms) within a group of diseases, can be applied to progressive pulmonary fibrosis. These targets for medical intervention can be identified through validated biomarkers and are not necessarily related to specific diagnostic labels. Proposed treatable traits are: cigarette smoking, occupational, allergen or drug exposures, excessive (profibrotic) auto- or alloimmunity, progressive pulmonary fibrosis, pulmonary hypertension, obstructive sleep apnea, tuberculosis, exercise intolerance, exertional hypoxia, and anxiety and depression. There are also several potential traits that have not been associated with relevant outcomes or for which no effective treatment is available at present: air pollution, mechanical stress, viral infections, bacterial burden in the lungs, surfactant-related pulmonary fibrosis, telomere-related pulmonary fibrosis, the rs35705950 MUC5B promoter polymorphism, acute exacerbations, gastro-esophageal reflux, dyspnea, and nocturnal hypoxia. The ‘treatable traits’ concept can be applied in new clinical trials for patients with progressive pulmonary fibrosis and could be used for developing new treatment strategies.

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The Spectrum of Drug-Induced Interstitial Lung Disease

Cited by 5 publications

References 41 publications

Trimethoprim-sulfamethoxazole-induced lung injury: a case report

Trimethoprim-sulfamethoxazole-induced lung injury: a case report

Drug-induced interstitial lung disease during cancer therapies: expert opinion on diagnosis and treatment

Towards Treatable Traits for Pulmonary Fibrosis

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