The Drug-Induced Respiratory Disease Website
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
Hypersensitivity pneumonitis associated with azathioprine therapy in a patient with granulomatosis with polyangiitis.
Rheumatology international 2016 Jul;36;1027-32 — 2016 Jul — 1027-32
Azathioprine induced pneumonitis in a patient with ulcerative colitis.
Journal of Crohn's & colitis 2009 Dec;3;309-12 — 2009 Dec — 309-12
[Azathioprine-associated interstitial pneumonitis].
Orvosi hetilap 2006 Feb 12;147;259-62 — 2006 Feb 12 — 259-62
Azathioprine-induced lung toxicity and efficacy of cyclosporin A in a young girl with type 2 autoimmune hepatitis.
Journal of pediatric gastroenterology and nutrition 2000 Aug;31;190-2 — 2000 Aug — 190-2
Azathioprine-associated pulmonary dysfunction.
Chest 1983 Apr;83;696-8 — 1983 Apr — 696-8
Interstitial pneumonitis secondary to azathioprine in a renal transplant patient.
Thorax 1983 Dec;38;951-2 — 1983 Dec — 951-2
Interstitial pneumonitis associated with azathioprine therapy.
American journal of clinical pathology 1978 Feb;69;181-5 — 1978 Feb — 181-5