Drug-induced pulmonary disease

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The most common adverse pulmonary responses produced by anticancer agents are interstitial pneumonitis and interstitial fibrosis. There is no sharp distinction between these two patterns of response and there may be progression from one state to another. In general, the presenting symptoms of interstitial pneumonitis are a more systemic, hypersensitivity response with fever, malaise, and a rapid decline in respiratory function. Although both entities can occur from days to years after medication is started and resolve from hours to months, interstitial pneumonitis is more likely to occur earlier and to resolve more quickly. Also, the pathologic differences are not profound. Interstitial pneumonitis shows evidence of larger numbers of inflammatory cells and less fibrosis than that of interstitial fibrosis. Of the two, interstitial pneumonitis is more likely to resolve upon withdrawal of the drug.

Common symptoms include the insidious onset of dyspnea and cough. The cough is usually dry although a thin, white sputum may be present at times. Malaise, fatigue, and fever occasionally occur. Physical examination generally reveals tachypnea and fine crackles, which are heard best in the bases. An interstitial infiltrate is the most common roentgenographic abnormality. Pulmonary function testing is consistent with a restrictive ventilatory defect (low vital capacity or total lung capacity) with a reduced diffusing capacity (DLCO); flow rates are usually preserved. The DLCO is the most sensitive parameter and may be used as a predictive test to follow the patient. Hypoxemia is common.

Diagnosis is made by lung biopsy. The list of causes of pulmonary . . .



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