The Drug-Induced Respiratory Disease Website

Azathioprine

Pneumonitis (ILD), acute and/or severe (may cause ARDS)

The restrictive lung dysfunction may be out of proportion with the mild changes seen on imaging

Ananthakrishnan AN, Attila T, Otterson MF, Lipchik RJ, Massey BT, Komorowski RA, Binion DG

Severe pulmonary toxicity after azathioprine/6-mercaptopurine initiation for the treatment of inflammatory bowel disease.

Journal of clinical gastroenterology 2007 Aug;41;682-8 — 2007 Aug — 682-8

Nagy F, Molnar T, Makula E, Kiss I, Milassin P, Zollei E, Tiszlavicz L, Lonovics J

A case of interstitial pneumonitis in a patient with ulcerative colitis treated with azathioprine.

World journal of gastroenterology 2007 Jan 14;13;316-9 — 2007 Jan 14 — 316-9

Rubin G, Baume P, Vandenberg R

Azathioprin nd acute restrictive lung disese.

Australian and New Zealand journal of medicine 1972 Aug;2;272-4 — 1972 Aug — 272-4

Weisenburger DD

Interstitial pneumonitis associated with azathioprine therapy.

American journal of clinical pathology 1978 Feb;69;181-5 — 1978 Feb — 181-5

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

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