Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches

Abstract

Drug-induced interstitial lung disease (DILD) is not uncommon and has many clinical patterns, ranging from benign infiltrates to life-threatening acute respiratory distress syndrome. There are two mechanisms involved in DILD, which are probably interdependent: one is direct, dose-dependent toxicity and the other is immune-mediated. Cytotoxic lung injury may result from direct injury to pneumocytes or the alveolar capillary endothelium. Drugs can induce all types of immunological reactions described by Gell and Coombs; however, most reactions in immune-mediated DILD may be T cell-mediated.DILD can be difficult to diagnose; diagnosis is often possible by exclusion alone. Identifying the causative drug that induces an allergy or cytotoxicity is essential for preventing secondary reactions.One method to confirm the diagnosis of a drug-induced disease is re-exposure or re-test of the drug. However, clinicians are reluctant to place patients at further risk of illness, particularly in cases with severe drug-induced diseases. Assessment of cell-mediated immunity has recently increased, because verifying the presence or absence of drug-sensitized lymphocytes can aid in confirmation of drug-induced disease. Using peripheral blood samples from drug-allergic patients, the drug-induced lymphocyte stimulation test (DLST) and the leukocyte migration test (LMT) can detect the presence of drug-sensitized T cells. However, these tests do not have a definite role in the diagnosis of DILD. This study explores the potential of these new tests and other similar tests in the diagnosis of DILD and provides a review of the relevant literature on this topic.

Leflunomide-Induced Interstitial Lung Disease: A Case Report

“…The clinical course can vary from benign lung infiltrations to mortal acute respiratory failure syndrome (1). In drug-induced ILDs, the causing mechanism has not been cleared yet.…”

“…In drug-induced ILDs, the causing mechanism has not been cleared yet. It is stated in the pathogenesis that lung cytotoxicity caused by drugs, immune response developing against drugs, and genetic predisposition have roles (1,2). Leflunomide (LEF) is an immunomodulator drug that plays a role in pyrimidine synthesis in T lymphocytes with its active metabolite A771726 and becomes effective by inhibiting the dihydroorotate dehydrogenase enzyme (2).…”

Drug-Induced Lung Disease: Report of Two Cases

“…İlaca bağlı akciğer hastalığı oluşumunda toksik ve immü-nolojik mekanizmalar sorumlu tutulmaktadır (5,6). Pulmoner parankimal hastalıklar, akut akciğer hasarı, pul-moner hemoraji, pulmoner vaskülopati, neoplastik durumlar, mediastinal, nöromuskuler ve plevral/perikardial patolojiler gibi çeşitli tablolar gelişebilmektedir (7).…”

“…Ancak bazen benign infiltratlarla karakterize olmasına karşın bazen de organize pnömoni ve akut respiratuar distres sendromuna yol açabilir (15). Olgularımızda da olduğu gibi hastalarda genellikle ateş, nonprodüktif öksürük ve dispne mevcut olup solunum fonksiyon testlerinde restriktif tipte solunum fonksiyon bozukluğu ve DLCO'da azalma vardır (6,16). İlaca bağlı akciğer hastalıklarında radyolojik bulgular genel olarak, bilateral, periferik yerleşimli, yama tarzında buzlu cam/konsolidasyon alanları ve septal kalınlaşma-lardan oluşmaktadır.…”

Ostre śródmiąższowe Zapalenie Płuc u Chorego na Reumatoidalne Zapalenie Stawów Leczonego Leflunomidem

“…Wiele leków stosowanych w terapii RZS może powodować toksyczne uszkodzenie płuc, a mechanizmy tego zjawiska nie są do końca znane. Istotne znaczenie w rozpoznaniu reakcji polekowej ma wywiad, z którego wynika, że chory przyjmował lek mogący wywoływać zmiany w płucach [12,13]. Wyróżnia się kilka typów odczynów polekowych w płucach.…”