Consensus statement for the diagnosis and treatment of drug-induced lung injuries (2024)

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Since imaging finding of drug-induced lung injury (DLI) is varying and nonspecific, diagnosis of DLI must be performed by the integration of clinical, imaging, and pathologic findings, when available. The roles of imaging evaluation in the diagnosis and treatment of DLI include detection of preexisting chronic fibrosing interstitial pneumonia as risk of DLI, early detection of DLI, diagnosis of DAD-type DLI for the estimation of prognosis, aids to differential diagnosis, follow-up examination including evaluation of treatment effect, and so on.

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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.

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2010 •

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Travis LB, Aziz N. Therapy-induced neoplasms. Drug-induced and Iatrogenic Respiratory Disease. 2010 Oct 29:218. (Chapter 20 Therapy Induced Neoplasms in Textbook Drug-induced and Iatrogenic Respiratory Disease. Philippe Camus and Edward C Rosenow Eds) This chapter focuses on selected highlights and findings in treatment-associated lung tumours, concentrating on survivors of adult cancer. In the present chapter we will focus on selected highlights and findings in treatment-associated lung tumours, concen- trating on survivors of adult cancer. Given the high baseline incidence rates of lung cancer in the general population,2 even a small increase in the relative risk can translate into large absolute risk, which is considered the optimal measure of disease burden in a population. The overall magnitude of lung cancer incidence, and the high associated mortality rate,2 emphasizes the importance of its occurrence as a second pri- mary cancer in cancer survivors. Given the known role of tobacco use in cancers which occur among lung cancer survi- vors, the occurrence of second primary lung cancers will not be addressed in this patient population; instead the reader is referred to the summary by Caporaso and colleagues.8 First published in Great Britain in 2010 by Hodder Arnold, an imprint of Hodder Education, an Hachette UK company, 338 Euston Road, London NW1 3BH © 2010 Edward Arnold (Publishers) Ltd

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Interstitial lung disease associated with drug therapy

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Consensus statement for the diagnosis and treatment of drug-induced lung injuries (2024)


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