The Drug-Induced Respiratory Disease Website and App

Infliximab

Specialities: Gastroenterology · Internal medicine · Rheumatology

Hypesrentitivity infusion reactions are common (PMID 12818276). For those ILD cases exposed to methotrexate concomitantly, drug causality assessment in regards to infliximab is difficult.

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.a

Pneumonitis (ILD), acute and/or severe (may produce the ARDS pattern)

I.b

Pneumonitis (interstitial lung disease/ILD)

I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d

Organizing pneumonia pattern (an area or areas of consolidation on imaging)

I.e

Acute eosinophilic pneumonia (AEP)

I.g

Pulmonary fibrosis

I.w

Rapidly progressive ILD/pulmonary fibrosis (a.k.a. Hamman-Rich syndrome)

I.y

Progression, acceleration or exacerbation of preexisting ILD/fibrosis

II - Pulmonary edema - Acute lung injury - ARDS

II.b

ARDS - Acute lung injury

III - Pulmonary/alveolar/airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

IV - Airway involvement

IV.a

Bronchospasm - Wheezing - Asthma

V - Pleural and/or pericardial involvement

V.a

Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

V.d

Pleural/pericardial effusion, ANA positive (DI lupus)

VI - Pulmonary vasculopathy

VI.a

Pulmonary embolism - Venous thrombosis/thromboembolism

VI.d

Pulmonary vasculitis or capillaritis

X - Systemic/Distant conditions, syndromes and reactions

X.a

DRES syndrome - DRESS-like reaction

X.b

Antiphospholipid antibodies w/wo the APL syndrome

X.d

Lupus - Lupus syndrome (see also Vd)

X.e

Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)

X.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)

X.g

Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)

X.h

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

X.j

Myopathy-Myositis-Polymyositis (see also under Xba)

X.k

Sarcoid-like granulomatosis (endo-/extrathoracic)

X.s

Vasculitis, pulmonary (w/wo AH), extrapulmonary, systemic: ANCA-positive

X.ah

Granulomatosis with polyangiitis (typically ANCA pos.) - GPA flare

X.ar

Relapse/flare/onset of Crohn's disease

XII - Cardiovascular involvement / toxicity

XII.c

Pericardial effusion (w/wo tamponade)

XII.d

Myocarditis (can be fulminant)

XII.q

Pericarditis (see also under XIIc)

XII.br

Right ventricular thrombus/thrombosis

XV - Pathology

XV.a

Path: NSIP-cellular pattern (see also Ia, Ib)

XV.f

Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

XV.cs

Path: Pleural granulomas

XVI - Imaging

XVI.b

Imaging: Ground-glass opacities (GGO) / shadowing

XVII - Infections & related conditions

XVII.b

Opportunistic pulmonary/systemic infections

XVII.c

Aspergillosis, pulmonary (invasive, allergic [ABPA], or mycetoma)

XVII.d

Pneumocystis jiroveci pulmonary colonization

XVII.e

Pneumocystis jiroveci pneumonia

XVII.f

Tuberculosis, miliary

XVII.g

Tuberculosis (pulmonary, pulmonary, extrapulmonary or disseminated). Reactivation or de novo

XVII.h

Nontuberculous pulmonary mycobacterial infection/superinfection

XVII.n

Legionella pneumophila pneumonia

XVII.o

Nocardia pulmonary/systemic infection

XVII.q

Viral pneumonia

XVII.r

Fungal infection (pulmonary/extrapulmonary)

XVII.y

Cryptococcus pulmonary and/or systemic infection

XVII.z

Histoplamosis (reactivation)

XVII.ac

Actinomycosis