The Drug-Induced Respiratory Disease Website

Adalimumab

Phrenic nerve injury - Hemi- or bilateral diaphragmatic paralysis

Definite or suggested by the finding of an elevated hemidiaphragm or diaphragm

Abdallah T, Abdallah M, Saifan C, El Sayegh D, Chalhoub M, Sasso L

Hemidiaphragm paresis and granulomatous pneumonitis associated with adalimumab: a case report.

Heart & lung : the journal of critical care 2014 Jan-Feb;43;84-6 — 2014 Jan-Feb — 84-6

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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