Pneumotox » Drug » Mitomycin C

Mitomycin C

Intra-vesical or -peritoneal mitomycin can also induce ILD/DAD (PMID 20130385, 19757670, 17434283)

Last update : 31/08/2012

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.b Pneumonitis (ILD)

I.g Pulmonary fibrosis

I.h Subclinical pulmonary infiltrates/ILD

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

I.v Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence

I.w Rapidly progressive ILD/pulmonary fibrosis (Hamman-Rich syndrome)

II.a Pulmonary edema, noncardiogenic (NCPE)

II.b ARDS - Acute lung injury

II.c ARDS and the hemolytic-uremic syndrome (HUS)

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

VI.b Pulmonary arterial hypertension

VI.c Pulmonary veno-occlusive disease

VI.f Hemolytic and uremic syndrome (HUS). See also under Xaf

VI.p Angiomatoid pulmonary vasculopathy

VIII.c Upper airway obstruction other than angioedema or hematoma

X.k Sarcoid-like granulomatosis (endo-/extrathoracic)

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

XV.i Path: Pneumocyte atypia (reactive epithelial cells) (a.k.a. the "Napoleon Hat" sign)

XV.ak Path: Pulmonary veno-occlusive disease (PVOD)

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

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

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France