The Drug-Induced Respiratory Disease Website

BCG therapy (topical instillations in the urinary bladder)

Lymphadenopathy (intrathoracic)

Can be hilar and/or mediastinal. Typically detected on imaging. Pathology may reveal granulomatous or reactive changes

Mehta AR, Mehta PR, Mehta RL

A cough conundrum in a patient with a previous history of BCG immunotherapy for bladder cancer.

BMJ case reports 2012 Oct 24;2012; — 2012 Oct 24

Chang H, Klein JS, Norotsky M, Cooper K

Granulomatous chest disease following intravesical bacillus Calmette-Guerin immunotherapy.

Journal of thoracic imaging 2004 Jan;19;60-2 — 2004 Jan — 60-2

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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