Philippe Camus, M.D.

Dijon, France

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XXIV.h

Pulmonary fibrosis (may improve but partly following drug discontinuation)

(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

Schwaiblmair M, Berghaus T, Haeckel T, Wagner T, von Scheidt W

Amiodarone-induced pulmonary toxicity: an under-recognized and severe adverse effect?

Clinical research in cardiology : official journal of the German Cardiac Society 2010 Nov;99;693-700 — 2010 Nov — 693-700

Papiris SA, Triantafillidou C, Kolilekas L, Markoulaki D, Manali ED

Amiodarone: review of pulmonary effects and toxicity.

Drug safety 2010 Jul 01;33;539-58 — 2010 Jul 01 — 539-58

Ghezel-Ahmadi V, Kürschner VC, Fisseler-Eckhoff A, Schirren J, Schmitz JE, Obenhaus T

[Amiodarone-induced pneumonitis. Lethal complication in a patient after thoracic surgery].

Der Anaesthesist 2008 Oct;57;982-7 — 2008 Oct — 982-7

Dezile G, Roullier A, Arbeille-Brassart B

[Interstitial pneumopathy in subjects treated with amiodarone].

Presse medicale (Paris, France : 1983) 1983 Nov 26;12;2747-50 — 1983 Nov 26 — 2747-50

Esinger W, Schleiffer T, Leinberger H, Hertrich F, Köhler G, Gröger C, Raute-Kreinsen U

[Steroid-refractory amiodarone-induced pulmonary fibrosis. Clinical features and morphology after an amiodarone-free interval of 3 months].

Deutsche medizinische Wochenschrift (1946) 1988 Oct 21;113;1638-41 — 1988 Oct 21 — 1638-41