The Drug-Induced Respiratory Disease Website

Pneumonitis (ILD)

Or 'ILD'. (Fr: PnP subaiguë). A.k.a. pulmonary infiltrates. Generally bilateral and symmetrical. Gradual onset. Consistent with but not specific for an NSIP-c pattern on pathology. Less- dense, severe, acute and diffuse than pattern Ia. Lacks the features of ARDS that may accompany pattern Ia. Can be in the form of disseminated linear, reticulonodular, miliary or patchy opacities. BAL is indicated to separate this pattern from PIE (Ic) or DAH (IIIa). Acute chest pain can be at the forefront. A search for microorganisms including Pneumocystis (stains, PCR) is indicated. On pathology (although not many cases undergo a confirmatory lung biopsy), there is interstitial inflammation and a more or less dense cellular interstitial cellular infiltrate (NSIP-c). Fibrosis, alveolar edema and/or a reactive epithelium denote those cases resulting from with antineoplastic chemotherapy agents. The frontier between patterns Ia and I b can be difficult to draw, so please check drugs under both Ia and Ib. Patients may quickly shift from pattern Ib to Ia particularly if the the causal drug is inappropriately continued. Prompt withdrawal must be considered, underlying disease permitting, and can be therapeutic.

Publications

Afflu DK, Cody BA, Lendermon E, Sanchez PG

The use of bilateral orthotopic lung transplantation in the management of acute severe drug-induced interstitial lung disease: A case report.

JHLT open 2024 Aug;5;100108 — 2024 Aug — 100108

Rubin J, Chiu ML, Mino-Kenudson M, Sharma A, Witkin AS, Moschovis PP, Vogel Y, Shelton K, Crowley J, Raz Y

ARDS With Pneumothorax in a Young Adult.

Chest 2022 Feb;161;e111-e116 — 2022 Feb — e111-e116

Miller JO, Shih AR, Mino-Kenudson M, Taylor MS, Goldman JL

Trimethoprim-Sulfamethoxazole Associated Fulminant Respiratory Failure in Children and Young Adults.

American journal of respiratory and critical care medicine 2021 Jan 29;; — 2021 Jan 29

Yuzurio S, Horita N, Shiota Y, Kanehiro A, Tanimoto M

Interstitial lung disease during trimethoprim/sulfamethoxazole administration.

Acta medica Okayama 2010 Jun;64;181-7 — 2010 Jun — 181-7

Oshitani N, Matsumoto T, Moriyama Y, Kudoh S, Hirata K, Kuroki T

Drug-induced pneumonitis caused by sulfamethoxazole, trimethoprim during treatment of Pneumocystis carinii pneumonia in a patient with refractory ulcerative colitis.

Journal of gastroenterology 1998 Aug;33;578-81 — 1998 Aug — 578-81

Cass RM

Adult respiratory distress syndrome and trimethoprim-sulfamethoxazole.

Annals of internal medicine 1987 Feb;106;331 — 1987 Feb — 331

Diagnosing DIRD