Philippe Camus, M.D.

Dijon, France

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The Drug-Induced Respiratory Disease Website

XXIV.a

Pneumonitis (ILD)

Or 'ILD'. (Fr: PnP subaiguë). A.k.a. pulmonary infiltrates. Generally bilateral and symmetrical. Gradual onset. Consistent with but not specific for an NSIP-c pattern on pathology. Less- dense, severe, acute and diffuse than pattern Ia. Lacks the features of ARDS that may accompany pattern Ia. Can be in the form of disseminated linear, reticulonodular, miliary or patchy opacities. BAL is indicated to separate this pattern from PIE (Ic) or DAH (IIIa). Acute chest pain can be at the forefront. A search for microorganisms including Pneumocystis (stains, PCR) is indicated. On pathology (although not many cases undergo a confirmatory lung biopsy), there is interstitial inflammation and a more or less dense cellular interstitial cellular infiltrate (NSIP-c). Fibrosis, alveolar edema and/or a reactive epithelium denote those cases resulting from with antineoplastic chemotherapy agents. The frontier between patterns Ia and I b can be difficult to draw, so please check drugs under both Ia and Ib. Patients may quickly shift from pattern Ib to Ia particularly if the the causal drug is inappropriately continued. Prompt withdrawal must be considered, underlying disease permitting, and can be therapeutic.

Publications

Kirby S, Satoskar A, Brodsky S, Pope-Harman A, Nunley D, Hitchcock C, Pelletier R, Ross P, Nadasdy T, Shilo K

Histological spectrum of pulmonary manifestations in kidney transplant recipients on sirolimus inclusive immunosuppressive regimens.

Diagnostic pathology 2012 Mar 14;7;25 — 2012 Mar 14 — 25

Lee HS, Huh KH, Kim YS, Kim MS, Kim HJ, Kim SI, Joo DJ

Sirolimus-induced pneumonitis after renal transplantation: a single-center experience.

Transplantation proceedings 2012 Jan;44;161-3 — 2012 Jan — 161-3

Morcos A, Nair S, Keane MP, McElvaney NG, McCormick PA

Interstitial pneumonitis is a frequent complication in liver transplant recipients treated with sirolimus.

Irish journal of medical science 2012 Jun;181;231-5 — 2012 Jun — 231-5

Das S, Cherian SV, Das N, Garcha AS, Lenox R, Sexton J

Persistent dyspnea in a 59-year-old woman receiving immunosuppressants.

Chest 2011 Sep;140;818-822 — 2011 Sep — 818-822

Flechner SM

Risk factors for and management of sirolimus-associated pneumonitis in kidney transplant recipients.

Nature clinical practice. Nephrology 2008 May;4;250-1 — 2008 May — 250-1

Weiner SM, Sellin L, Vonend O, Schenker P, Buchner NJ, Flecken M, Viebahn R, Rump LC

Pneumonitis associated with sirolimus: clinical characteristics, risk factors and outcome--a single-centre experience and review of the literature.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2007 Dec;22;3631-7 — 2007 Dec — 3631-7

Delgado JF, Torres J, José Ruiz-Cano M, Sánchez V, Escribano P, Borruel S, María Cortina J, de la Calzada CS

Sirolimus-associated interstitial pneumonitis in 3 heart transplant recipients.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2006 Sep;25;1171-4 — 2006 Sep — 1171-4

Howard L, Gopalan D, Griffiths M, Mahadeva R

Sirolimus-induced pulmonary hypersensitivity associated with a CD4 T-cell infiltrate.

Chest 2006 Jun;129;1718-21 — 2006 Jun — 1718-21

Champion L, Stern M, Israël-Biet D, Mamzer-Bruneel MF, Peraldi MN, Kreis H, Porcher R, Morelon E

Brief communication: sirolimus-associated pneumonitis: 24 cases in renal transplant recipients.

Annals of internal medicine 2006 Apr 04;144;505-9 — 2006 Apr 04 — 505-9

Hamour IM, Mittal TK, Bell AD, Banner NR

Reversible sirolimus-associated pneumonitis after heart transplantation.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2006 Feb;25;241-4 — 2006 Feb — 241-4

Garrean S, Massad MG, Tshibaka M, Hanhan Z, Caines AE, Benedetti E

Sirolimus-associated interstitial pneumonitis in solid organ transplant recipients.

Clinical transplantation 2005 Oct;19;698-703 — 2005 Oct — 698-703

Chhajed PN, Dickenmann M, Bubendorf L, Mayr M, Steiger J, Tamm M

Patterns of pulmonary complications associated with sirolimus.

Respiration; international review of thoracic diseases 2006;73;367-74 — 2006 — 367-74

Jiménez-Rivera C, Avitzur Y, Fecteau AH, Jones N, Grant D, Ng VL

Sirolimus for pediatric liver transplant recipients with post-transplant lymphoproliferative disease and hepatoblastoma.

Pediatric transplantation 2004 Jun;8;243-8 — 2004 Jun — 243-8

Pham PT, Pham PC, Danovitch GM, Ross DJ, Gritsch HA, Kendrick EA, Singer J, Shah T, Wilkinson AH

Sirolimus-associated pulmonary toxicity.

Transplantation 2004 Apr 27;77;1215-20 — 2004 Apr 27 — 1215-20

Haydar AA, Denton M, West A, Rees J, Goldsmith DJ

Sirolimus-induced pneumonitis: three cases and a review of the literature.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2004 Jan;4;137-9 — 2004 Jan — 137-9