Pneumotox » Drug » Phenytoin (diphenylhydantoin)

Phenytoin (diphenylhydantoin)

4

Last update : 20/11/2013

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

1

I.b Pneumonitis (ILD)

1

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

1

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

1

I.k Lung nodule or nodules

1

II.b ARDS - Acute lung injury

1

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

1

III.b Pneumorenal syndrome (w/wo ANCAs)

1

IV.a Bronchospasm - Wheezing - Asthma

1

IV.d Cough (lone)

1

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

1

VI.d Pulmonary vasculitis or capillaritis

1

VII.a Lymphadenopathy (intrathoracic)

2

VII.b Lymphadenopathy with reactive changes

1

VII.m Malignant lymphoma

1

X.a DRES syndrome - DRESS-like reaction

2

X.d Lupus - Lupus syndrome (see also Vd)

1

X.h Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

-

X.m Vascultis (pulmonary, extrathoracic or systemic)-ANCA status unknown or negative)

1

X.u Multiple organ dysfunction/failure (MODS/MOF)

1

XI.ab Gingival hypertrophy

2

XII.m Cardiac- cardiorespiratory/pulmonary arrest

1

XII.x Sinus arrest

1

XII.as Giant cell myocarditis

1

XIII.b Lymphoproliferative disease (pulmonary, endobronchial, endothoracic)

1

XIV.a Methemoglobinemia

1

XV.m Path: Lymphoid hyperplasia (including nodular- or a lymphocytic interstitial pneumonia pattern)

1

XV.ab Path: Pulmonary capillaritis

1

XV.ac Path: Pulmonary vasculitis other than capillaritis

1

XV.af Path: Granulomatous pulmonary vasculitis

1

XIX.a BAL: An excess proportion of lymphocytes

1

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

More detailed checklist