The Drug-Induced Respiratory Disease Website

BCG therapy (topical instillations in the urinary bladder)

Multiple organ dysfunction/failure (MODS/MOF)

Delimpoura V, Samitas K, Vamvakaris I, Zervas E, Gaga M

Concurrent granulomatous hepatitis, pneumonitis and sepsis as a complication of intravesical BCG immunotherapy.

BMJ case reports 2013 Oct 10;2013; — 2013 Oct 10

Kaklamanos M, Hardavella G, Trigidou R, Dionellis G, Paissios N, Koulouris N, Goritsas C

Multi-organ failure with atypical liver granulomas following intravesical Bacillus Calmette-Guerin instillation.

World journal of hepatology 2011 Mar 27;3;79-82 — 2011 Mar 27 — 79-82

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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