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Diagnosing DIRD
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The Drug-Induced Respiratory Disease Website
Philippe Camus, M.D.
Dijon, France
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Drugs
Patterns
Irinotecan
2
Last update :
20/01/2012
I - Interstitial/parenchymal lung disease
I.b
Pneumonitis (ILD)
2
II - Pulmonary edema - Acute lung injury - ARDS
II.b
ARDS - Acute lung injury
2
III - Pulmonary/alveolar./airway hemorrhage/bleeding
III.a
Alveolar hemorrhage (AH), diffuse AH (DAH)
-
XV - Pathology
XV.f
Path: Diffuse alveolar damage (DAD-pattern) (see also IL)
1
XV.i
Path: Pneumocyte atypia (reactive epithelial cells) (a.k.a. the "Napoleon Hat" sign)
1
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Identify causative drugs
Diagnosing DIRD
1
Drug and radiation history
2
Drug singularity - Correct identification of the drug
3
Consistent timing of exposure v. onset of symptoms
4
Clinical, imaging, BAL, pathological pattern consistent with the specific drug
5
Careful exlusion of another cause
6
Remission of symptoms with removal of drug
7
Recurrence with rechallenge (rarely advisable)
8
Causality assessment
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