Drug-induced lung disease can result from a number of agents and may have a myriad of presentations, ranging from an adult respiratory distress syndrome type picture to established pulmonary fibrosis.
Due to this, it can be extremely difficult to pinpoint the offending agent on imaging appearances alone and correlation with the medical history is mandatory.
Pathology
Etiology
Chemotherapy agents
These can give several patterns of disease which include 1,5:
interstitial fibrosis: typically NSIP 5 pattern
hypersensitivity pneumonitis pattern
adult respiratory distress syndrome / diffuse alveolar damage pattern
bronchiolitis obliterans organizing pneumonia type pattern
Example agents include:
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crizotinib: crizotinib associated intersitial pneumonitis
tyrosine kinase inhibitors: alectinib 18
-
epidermal growth factor receptor inhibitors tyrosine kinae inhibitors:
osimertinib 19
Immunosuppressive agents
sirolimus: sirolimus-associated pulmonary toxicity 9
leflunomide (arava): leflunomide-induced acute interstitial pneumonia 10
Immunotherapy agents
Immune checkpoint inhibitor therapy-related pneumonitis / immune-mediated pneumonitis usually happens between 8 to 14 weeks after the start of treatment 13. Examples of agents include:
nivolumab
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pembrolizumab
ipilimumab
Disease-modifying antirheumatic drugs (DMARDs)
TNF-alpha blockers: adalimumab-induced interstitial lung disease 16
Cardiovascular agents
amiodarone lung toxicity
Antibiotic agents
Can also give similar patterns to that of chemotherapeutic agents:
Anti-inflammatory agents
Non-medical drug use
IV methylphenidate: Ritalin lung, panacinar emphysema
IV heroin: pulmonary edema, pulmonary hemorrhage, eosinophilic pneumonia 6
IV cocaine: pulmonary edema
Anticonvulsants
phenytoin: eosinophilic pneumonia 4
Others
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herbicides
paraquat (N,N′-dimethyl-4,4′-bipyridinium dichloride): paraquat-induced lung disease