Drug-Induced Lung Disease: A Pragmatic Classification Incorporating HRCT Appearances

 

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ABSTRACT

Drug-induced lung disease frequently poses a diagnostic challenge. Knowledge of common radiological patterns of lung involvement and corresponding histopathologic diagnoses can facilitate management of individual patients. We outline a framework for understanding radiological and histologic patterns of drug-induced lung disease. Diffuse forms of drug-induced lung disease include processes that mimic acute respiratory distress syndrome (ARDS) and diffuse alveolar hemorrhage. These patterns of drug-induced lung disease are especially common in patients receiving cytotoxic chemotherapeutic agents. Chronic forms of drug-induced lung disease include many of the interstitial pneumonias seen more commonly in patients with idiopathic disease. Bronchiolitis obliterans organizing pneumonia and eosinophilic pneumonia are nonspecific patterns of drug-induced lung disease that are radiologically and histologically indistinguishable from their idiopathic counterparts. In some patients organizing pneumonia and eosinophilic pneumonia mimic the radiological appearance of neoplastic disease.

REFERENCES

• 1 Padley S, Adler B, Hansell D. et al . High-resolution computed tomography of drug-induced lung disease.  Clin Radiol. 1992;  46 232-236
  CrossrefPubMedGoogle Scholar
• 2 Cleverly J, Screaton N, Hiorns M. et al . Drug-induced lung disease: high-resolution CT and histologic findings.  Clin Radiol . 2002;  57 292-299
  CrossrefPubMedGoogle Scholar
• 3 Cooper Jr A J. Drug-induced lung disease. Advances in Internal Medicine .  1997;  42 231-268
  PubMedGoogle Scholar
• 4 Cooper Jr A J, White D A, Matthay R A. Drug-induced pulmonary disease, II: Noncytotoxic drugs.  Am Rev Respir Dis . 1986;  133 488-505
  PubMedGoogle Scholar
• 5 Cooper Jr A J, White D A, Matthay R A. Drug-induced pulmonary disease, I: Cytotoxic drugs.  Am Rev Respir Dis . 1986;  133 321-340
  PubMedGoogle Scholar
• 6 Aronchick J, Gefter W. Drug-induced pulmonary disorders.  Semin Roentgenol . 1995;  30 18-34
  PubMedGoogle Scholar
• 7 Ellis S, Cleverly J, Müller N. Drug-induced lung disease: high-resolution CT findings.  AJR Am J Roentgenol . 2000;  175 1019-1024
  PubMedGoogle Scholar
• 8 Myers J. Pathology of drug-induced lung disease. In: Katzenstein A-L, Askin F, eds. Surgical Pathology of Nonneoplastic Lung Disease Philadelphia: WB Saunders 1997: 81-111
  Google Scholar
• 9 Myers J L. Diagnosis of drug reactions in the lung. In: Churg A, Katzenstein A-L, eds. The Lung: Current Concepts Balimore: Williams and Wilkins 1993: 32-53
  Google Scholar
• 10 Rosenow III C E, Myers J L, Swensen S J. et al . Drug-induced pulmonary disease: an update.  Chest . 1992;  102 239-250
  PubMedGoogle Scholar
• 11 Rosenow E, Limper A. Drug-induced pulmonary disease.  Semin Respir Infect . 1995;  10 86-95
  PubMedGoogle Scholar
• 12 Erasmus J, McAdams H, Rossi S. Drug-induced lung injury.  Semin Roentgenol . 2002;  37 72-81
  PubMedGoogle Scholar
• 13 Erasmus J, McAdams P, Rossi S. High-resolution CT of drug-induced lung disease.  Radiol Clin of N Am . 2002;  40 61-72
  PubMedGoogle Scholar
• 14 Rossi S, Erasmus J, McAdams H. et al . Pulmonary drug toxicity: radiologic and pathologic manifestations.  RadioGraphics . 2000;  20 1245-1259
  CrossrefPubMedGoogle Scholar
• 15 Imokawa S, Colby T, Leslie K. et al . Methotrexate pneumonitis: review of the literature and histopathological findings in nine patients.  Euro Respir J . 2000;  15 373-381
  CrossrefPubMedGoogle Scholar
• 16 Heard B, Cooke R. Busulphan lung.  Thorax . 1968;  23 187-193
  PubMedGoogle Scholar
• 17 Dean P, Groshart K, Porterfield J. et al . Amiodarone-associated pulmonary toxicity: a clinical and pathologic study of eleven cases.  Am J Clin Pathol . 1987;  87 7-13
  PubMedGoogle Scholar
• 18 Myers J, Kennedy J, Plumb V. Amiodarone lung: pathologic findings in clinically toxic patients.  Hum Pathol . 1987;  18 349-354
  CrossrefPubMedGoogle Scholar
• 19 Dhillon S, Singh D, Doe N. et al . Diffuse alveolar hemorrhage and pulmonary capillaritis due to propylthiouracil.  Chest . 1999;  116 1485-1488
  CrossrefPubMedGoogle Scholar
• 20 Hasleton P, O'Driscoll B, Lynch P. et al . Late BCNU lung: a light and ultrastructural study on the delayed effect of BCNU on the lung parenchyma.  J Pathol . 1991;  164 31-36
  PubMedGoogle Scholar
• 21 O'Driscoll B, Hasleton P, Taylor P. et al . Active lung fibrosis up to 17 years after chemotherapy with carmustine (BCNU) in childhood.  N Engl J Med . 1990;  323 378-382
  PubMedGoogle Scholar
• 22 O'Driscoll B, Kalra S, Gattamaneni H. et al . Late carmustine lung fibrosis: age at treatment may influence severity and survival.  Chest . 1995;  107 1355-1357
  PubMedGoogle Scholar
• 23 Taylor P, O'Driscoll B, Gattmaneni H. et al . Chronic lung fibrosis following carmustine (BCNU) chemotherapy: radiologic features.  Clin Radiol . 1991;  44 299-301
  CrossrefPubMedGoogle Scholar
• 24 Dusman R, Stanton M, Miles W. et al . Clinical features of amiodarone-induced pulmonary toxicity.  Circulation . 1990;  82 51-59
  PubMedGoogle Scholar
• 25 Fraire A, Guntupalli K, Greenberg S. et al . Amiodarone pulmonary toxicity: a multidisciplinary review of current status.  South Med J . 1993;  86 67-77
  PubMedGoogle Scholar
• 26 Kennedy J. Clinical aspects of amiodarone pulmonary toxicity.  Clin Chest Med . 1990;  11 119-129
  PubMedGoogle Scholar
• 27 Kennedy J, Myers J, Plumb V. et al . Amiodarone pulmonary toxicity: clinical, radiologic, and pathologic correlations.  Arch Intern Med . 1987;  147 50-55
  CrossrefPubMedGoogle Scholar
• 28 Martin II W, Rosenow III E. Amiodarone pulmonary toxicity: recognition and pathogenesis.  Chest . 1988;  93(pts I and II) 1067-1248
  PubMedGoogle Scholar
• 29 Vrobel T, Miller P, Mostow N. et al . A general overview of amiodarone toxicity: its prevention, detection, and management.  Prog in Cardio Dis . 1989;  31 393-426
  PubMedGoogle Scholar
• 30 Adams G, Kenoe R, Lesch M. et al . Amiodarone-induced pneumonitis: assessment of risk factors and possible risk reduction.  Chest . 1988;  93 254-263
  PubMedGoogle Scholar
• 31 Herre J, Sauve M, Malone P. et al . Long-term results of amiodarone therapy in patients with recurrent sustained ventricular tachycardia or ventricular fibrillation.  J Am Coll Cardiol . 1989;  13 442-449
  PubMedGoogle Scholar
• 32 Kuhlman J, Teigen C, Ren H. et al . Amiodarone pulmonary toxicity: CT findings in symptomatic patients.  Radiology . 1990;  177 121-125
  PubMedGoogle Scholar
• 33 Ren H, Kuhlman J, Hruban R. et al . CT-pathology correlation of amiodarone lung.  J Comp Assist Tomogr . 1990;  14 760-765
  PubMedGoogle Scholar
• 34 Siniakowicz R, Narula D, Suster B. et al . Diagnosis of amiodarone pulmonary toxicity with high-resolution computerized tomographic scan.  J Cardiovasc Electrophysiol . 2001;  12 431-436
  CrossrefPubMedGoogle Scholar
• 35 Vernhet H, Bousquet C, Durand G. et al . Reversible amiodarone-induced lung disease: HRCT findings.  Eur Radiol . 2001;  11 1697-1703
  CrossrefPubMedGoogle Scholar
• 36 Stein M, Demarco T, Gamsu G. et al . Computed tomography: pathologic correlation in lung disease due to tocainide.  Am Rev Respir Dis . 1988;  137 458-460
  PubMedGoogle Scholar
• 37 Holmberg L, Boman G. Pulmonary reactions to nitrofurantoin: 447 cases reported to the Swedish Adverse Drug Reaction Committee 1966-1976.  Euro J Respir Dis . 1981;  62 180-189
  PubMedGoogle Scholar
• 38 Sheehan R, Wells A, Milne D. et al . Nitrofurantoin-induced lung disease: two cases demonstrating resolution of apparently irreversible CT abnormalities.  J Comp Assist Tomogr . 2000;  24 259-261
  PubMedGoogle Scholar
• 39 Israel K, Brashear R, Sharma H. et al . Pulmonary fibrosis and nitrofurantoin.  Am Rev Respir Dis . 1973;  108 353-356
  PubMedGoogle Scholar
• 40 Rosenow E, DeRemee R, Dines D. Chronic nitrofurantoin pulmonary reaction: report of five cases.  N Engl J Med . 1968;  279 1258-1262
  CrossrefPubMedGoogle Scholar
• 41 Strandberg I, Wengle B, Fagrell B. Chronic interstitial pneumonitis with fibrosis during long-term treatment with nitrofurantoin.  Acta Med Scand . 1974;  196 483-487
  PubMedGoogle Scholar
• 42 Cameron R, Kolbe J, Wilsher M. et al . Bronchiolitis obliterans organising pneumonia associated with the use of nitrofurantoin.  Thorax . 2000;  55 249-251
  CrossrefPubMedGoogle Scholar
• 43 Bone R, Wolfe J, Sobonya R. et al . Desquamative interstitial pneumonia following long-term nitrofurantoin therapy.  Am J Med . 1976;  60 697-701
  CrossrefPubMedGoogle Scholar
• 44 Magee F, Wright J, Chan N. et al . Two unusual pathological reactions to nitrofurantoin: case reports.  Histopathology . 1986;  10 701-706
  PubMedGoogle Scholar
• 45 Goodman T, Polisson R. Methotrexate: adverse reactions and major toxicities.  Rheum Dis Clin N Amer . 1994;  20 513-528
  PubMedGoogle Scholar
• 46 Hargreaves M, Mowat A, Benson M. Acute pneumonitis associated with low dose methotrexate treatment for rheumatoid arthritis: report of five cases and review of published reports.  Thorax . 1992;  47 628-633
  CrossrefPubMedGoogle Scholar
• 47 Sostman H, Matthay R, Putman C. et al . Methotrexate-induced pneumonitis.  Medicine . 1976;  55 371-388
  PubMedGoogle Scholar
• 48 Alarcon G, Kremer J, Macaluso M. et al . Risk factors for methotrexate-induced lung injury in patients with rheumatoid arthritis: a multicenter, case-control study.  Ann Intern Med . 1997;  127 356-364
  PubMedGoogle Scholar
• 49 Dawson J, Graham D, Desmond J. et al . Investigation of the chronic pulmonary effects of low-dose oral methotrexate in patients with rheumatoid arthritis: a prospective study incorporating HRCT scanning and pulmonary function tests.  Rheumatology . 2002;  41 262-267
  CrossrefPubMedGoogle Scholar
• 50 Kremer J, Alarcon G, Weinblatt M. et al . Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review.  Arthritis Rheum . 1997;  40 1829-1837
  CrossrefPubMedGoogle Scholar
• 51 Clarysse A, Cathey W, Cartwright G. et al . Pulmonary disease complicating intermittent therapy with methotrexate.  JAMA . 1969;  209 1861-1864
  CrossrefPubMedGoogle Scholar
• 52 Everts C, Westcott J, Bragg D. Methotrexate therapy and pulmonary disease.  Radiology . 1973;  107 539-543
  PubMedGoogle Scholar
• 53 Green L, Schattner A, Berkenstadt H. Severe reversible interstitial pneumonitis induced by low dose methotrexate: report of a case and review of the literature.  J Rheumatol . 1988;  15 110-112
  PubMedGoogle Scholar
• 54 Leduc D, De Vuyst P, Lheureux P. Pneumonitis complicating low-dose methotrexate therapy for rheumatoid arthritis: discrepancies between lung biopsy and bronchoalveolar lavage findings.  Chest . 1993;  104 1620-1623
  PubMedGoogle Scholar
• 55 Nesbit M, Krivit W, Heyn R. et al . Acute and chronic effects of methotrexate on hepatic, pulmonary, and skeletal systems.  Cancer . 1976;  37 1048-1054
  PubMedGoogle Scholar
• 56 Arakawa H, Kurihara Y, Niimi H. et al . Bronchiolitis obliterans with organizing pneumonia versus chronic eosinophilic pneumonia: high-resolution CT findings in 81 patients.  AJR Am J Roentgenol . 2001;  176 1053-1058
  PubMedGoogle Scholar
• 57 Cohen M, Austin J, Smith-Vaniz A. Nodular bleomycin toxicity.  Am J Clin Pathol . 1989;  92 101-104
  PubMedGoogle Scholar
• 58 Nachman J, Baum E, White H. et al . Bleomycin-induced pulmonary fibrosis mimicking recurrent metastatic disease in a patient with testicular carcinoma: case report of the CT scan appearance.  Cancer . 1981;  47 236-239
  PubMedGoogle Scholar
• 59 Trump D, Bartel E, Pozniak M. Nodular pneumonitis after chemotherapy for germ cell tumors.  Ann Intern Med . 1988;  109 431-432
  PubMedGoogle Scholar
• 60 Milesi-Lecat A-M, Schmidt J, Aumaitre O. et al . Lupus and pulmonary nodules consistent with bronchiolitis obliterans organizing pneumonia induced by carbamazepine.  Mayo Clin Proc . 1997;  72 1145-1147
  PubMedGoogle Scholar