Diagnosis and management of drug-associated interstitial lung disease

Abstract

Symptoms of drug-associated interstitial lung disease (ILD) are nonspecific and can be difficult to distinguish from a number of illnesses that commonly occur in patients with non-small-cell lung cancer (NSCLC) on therapy. Identification of drug involvement and differentiation from other illnesses is problematic, although radiological manifestations and clinical tests enable many of the alternative causes of symptoms in advanced NSCLC to be excluded. In lung cancer patients, high-resolution computed tomography (HRCT) is more sensitive than a chest radiograph in evaluating the severity and progression of parenchymal lung disease. Indeed, the use of HRCT imaging has led to the recognition of many distinct patterns of lung involvement and, along with clinical signs and symptoms, helps to predict both outcome and response to treatment. This manuscript outlines the radiology of drug-associated ILD and its differential diagnosis in NSCLC. An algorithm that uses clinical tests to exclude alternative diagnoses is also described.

Oxaliplatin-induced lung injury with allergic reaction

“…We diagnosed this case by referring to previously published reports [7] . Differential diagnoses of abnormal chest shadows during treatment for malignancies are infections, heart failure, lung bleeding, lymphangitis, and drug toxicity, including allergy.…”

Female Pelvis: Genital Organs

“…CT plays a major role in making a diagnosis since it is not only the most sensitive method for detection but also the best and most accurate method to identify the extent and pattern of pulmonary parenchymal changes (Mueller et al 2004 ;Silva and Mueller 2006 ;Walsh and Hansell 2014 ;Ellis et al 2000 ;Myers et al 2003 ). Diagnosis of drug-induced lung disease generally depends on a temporal association between exposure to the causative agent and the development of respiratory signs and symptoms.…”

Interstitial Lung Disease Induced by Targeted Therapy for Non-Small Cell Lung Cancer: A Review of Diagnosis, Workup, and Management

“…Pulmonary function tests are used to measure the severity of pulmonary impairment rather than to provide a specific diagnosis. Bronchoscopic examinations, such as bronchoalveolar lavage and transbronchial lung biopsy, are helpful to distinguish other processes, including infectious causes, lymphangitic carcinomatosis, diffuse alveolar hemorrhage, etc [1,46,47]. Proper evaluations of these examinations and clinical manifestations to establish the diagnosis is very important, because DILD may have significant influence on the treatment.…”

“…), the initiation of systemic corticosteroid therapy is recommended. Oral prednisolone or methylprednisolone (0.5-1 mg/kg/day) is generally used according to the previous reports [4,6,44,47]. Once patients suffered from rapidly progressive symptoms or more severe symptoms, high-dose steroid therapy (≥ 2 mg/kg/day methylprednisolone) should be used [6,47].…”

“…Oral prednisolone or methylprednisolone (0.5-1 mg/kg/day) is generally used according to the previous reports [4,6,44,47]. Once patients suffered from rapidly progressive symptoms or more severe symptoms, high-dose steroid therapy (≥ 2 mg/kg/day methylprednisolone) should be used [6,47]. In patients with impending respiratory failure or respiratory failure requiring mechanical ventilation, administratoin of intravenous methylprednisolone up to 500-1000 mg/day for 3 days had been demonstrated in the anecdotal reports [44,47,49].…”