Pneumotox » Drug » Fluorouracil (5-FU)

Fluorouracil (5-FU)

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First report of 5FU toxicity was in 1979. Recent reports insist of pulmonary toxicity of FOLFOX, and FOLFIRI, regimens to which 5-FU belongs. 5FU is also known to produce acute coronary spasm and pulmonary edema. Cardiotoxicity at PMID 25186061. The 5-FU prodrug S-1 may also cause lung injury

Last update : 29/11/2014

I.g Pulmonary fibrosis

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I.l Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf)

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II.a Pulmonary edema, noncardiogenic (NCPE)

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II.d Pulmonary edema, cardiogenic

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IV.c Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx)

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IV.n Obstructive airway dysfunction (see also IVc, XVx)

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X.f Anaphylaxis-Anaphylactoid reaction (can be fatal)

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XI.b Chest pain (acute or subacute), lone or prominent

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XI.ap Halitosis - Breath malodor

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XII.a Left or biventricular dysfunction/failure

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XII.c Pericardial effusion (w/wo tamponade)

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XII.e Takotsubo (stress) cardiomyopathy

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XII.g Coronary artery disease (acute) - Myocardial ischemia/infarction

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XII.l Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)

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XII.m Cardiac- cardiorespiratory/pulmonary arrest

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XII.w Asystole

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XII.af Coronary vasospasm - Vasospastic angina

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XII.ai Cardiotoxicity

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XV.z Path: Obliterative (constrictive) bronchiolitis (see also IVc, IVn)

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Diagnosing DIRD

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Drug and radiation history

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Drug singularity - Correct identification of the drug

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Consistent timing of exposure v. onset of symptoms

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Clinical, imaging, BAL, pathological pattern consistent with the specific drug

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Careful exlusion of another cause

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Remission of symptoms with removal of drug

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Recurrence with rechallenge (rarely advisable)

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Causality assessment

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