The Drug-Induced Respiratory Disease Website

BCG therapy (topical instillations in the urinary bladder)

Pleural effusion (uni or bilateral) (can accompany ILD induced by the drug)

Pleural effusion was not in isolation (PMID 24593234), but instead it was associated with BCG-induced ILD

Nimmo A, Gray A, Patel A, MacKenzie J, Fairbairn I

Pleural effusion as a late complication of intravesical BCG treatment.

Thorax 2018 04;73;393-394 — 2018 04 — 393-394

Tobiume M, Shinohara T, Kuno T, Mukai S, Naruse K, Hatakeyama N, Ogushi F

BCG-induced pneumonitis with lymphocytic pleurisy in the absence of elevated KL-6.

BMC pulmonary medicine 2014 Mar 05;14;35 — 2014 Mar 05 — 35

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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