The Drug-Induced Respiratory Disease Website

Proton beam therapy

Esophageal pleural fistula

Ali O, Challa SR, Siddiqui OM, Ali S, Kim RE

A rare cause of esophagopleural fistula due to intensity-modulated proton therapy: a case report and review of literature.

Clinical journal of gastroenterology 2021 Aug;14;955-960 — 2021 Aug — 955-960

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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