Fact-sheet: Drug-induced interstitial lung disease
Updated on 01/03/2023 at 10:21 AM
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Definition
Diffuse interstitial lung disease secondary to drug use: amiodarone, methotrexate, beta-blocker, or other.
Pathologically: cellular or fibrotic interstitial infiltrate, followed by irreversible fibrosis.
Clinical features
Exertional dyspnea, ± dry cough, nonspecific, with gradual onset.
Less commonly:
- dry, Velcro-like crackles
- clubbing: nonspecific
- incidental finding on chest imaging
- found during workup of another condition (connective tissue disease in particular)
CT
Nonspecific, diagnosis of exclusion.
Refer to the website:
Possible elementary lesions:
- perilymphatic/diffuse (micro)nodules
- inter/intralobular reticulations
- alveolar consolidations/ground-glass opacity
- honeycombing
- traction bronchiectasis
Regarding amiodarone-induced interstitial lung disease:
- peripheral consolidations
- ground-glass opacity
- reticulonodular opacities and interstitial involvement
- hepatic hyperdensity (80%), splenic, cardiac (20%) (visible even in the absence of toxicity)
Management
Treatment discontinuation
Corticosteroid therapy
Differential diagnosis
The 10 groups of subacute or chronic diffuse interstitial lung disease (according to the French College of Pulmonology Teachers - 2018):
- ILD associated with connective tissue disease Rheumatoid arthritis
- Scleroderma
- Hypersensitivity pneumonitis (HP) Bird fancier's lung
- Farmer's lung
- Drug-induced lung disease
- Malignant proliferations Lymphangitic carcinomatosis
- Lepidic adenocarcinoma
- Pneumoconiosis Silicosis
- Asbestos related disease
- Infection Tuberculosis
- Left heart failure
- Sarcoidosis
- Idiopathic ILD Idiopathic pulmonary fibrosis
- Nonspecific interstitial pneumonia
- Cryptogenic organizing pneumonia
- Other
- Other well-defined entities