The Drug-Induced Respiratory Disease Website
(Fr: fibrose pulmonaire). The background incidence of idiopathic pulmonary fibrosis (IPF) has to be taken into account for causality assessment. Imaging at PMID 23672718. The diagnosis of interstitial pulmonary fibrosis�is raised in the presence of linear pulmonary opacities and architectural distortion on imaging incl. HRCT, restrictive lung dysfunction, low KCO, and hypoxemia obviating the need for a lung biopsy. Presentation can be chronic, subacute or rapidly progressive. Generally, the condition develops insidiously with dyspnea and bibasilar or diffuse reticular or streaky opacities. Honeycombing can develop with time in longterm survivors. DI-fibrosis may follow a classic episode of chemotherapy- or amiodarone-induced pulmonary toxicity. Separation of DI-fibrosis from idiopathic or CTD (viz. RA or scleroderma)-related fibrosis can be arduous (PMID 23791462).�Patients may exacerbate and progress to ARDS. DI-fibrosis may develop late after completion of therapy with chemo agents, irradiation or amiodarone with no evidence of toxicity during treatment or in the meantime. DI-fibrosis rarely occurs as a complication of patterns Ia, b or c. Oxygen and irradiation can trigger the onset of or exacerbate DI-fibrosis. When DI-fibrosis develops during treatment with the offending agent, drug withdrawal may translate into some improvement. Costicosteroid therapy is indicated, but the results are unpredictable
Publications
Tumor necrosis factor inhibitors and lung disease: a paradox of efficacy and risk.
Seminars in arthritis and rheumatism 2010 Oct;40;147-63 — 2010 Oct — 147-63
Dastmalchi M, Grundtman C, Alexanderson H, Mavragani CP, Einarsdottir H, Helmers SB, Elvin K, Crow MK, Nennesmo I, Lundberg IE
A high incidence of disease flares in an open pilot study of infliximab in patients with refractory inflammatory myopathies.
Annals of the rheumatic diseases 2008 Dec;67;1670-7 — 2008 Dec — 1670-7
[TNF blockade in rheumatoid arthritis can cause severe fibrosing alveolitis. Six case reports].
Lakartidningen 2005 Dec 5-11;102;3788-90, 3793 — 2005 Dec 5-11 — 3788-90, 3793
Severe interstitial pneumonitis associated with infliximab therapy.
Scandinavian journal of rheumatology 2004;33;276-7 — 2004 — 276-7