Pneumotox » Drug » Corticosteroids, systemic (oral, parenteral)

Corticosteroids, systemic (oral, parenteral)

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Longterm oral or parenteral CST (PMID 11239846) poses the risk of opportunistic pulmonary (PMID 20736243, 2817582) and/or systemic infections (PMID 23982055). Continued attention is required as the use of costicosteroids may be increasing (PMID 21393338)

Last update : 20/01/2015

I.y Progression, acceleration or exacerbation of preexisting ILD/fibrosis

1

II.a Pulmonary edema, noncardiogenic (NCPE)

1

II.d Pulmonary edema, cardiogenic

2

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

1

III.b Pneumorenal syndrome (w/wo ANCAs)

1

IV.f Severe or catastrophic bronchospasm or asthma attack (can be fatal)

1

VI.a Pulmonary embolism - Venous thrombosis/thromboembolism

2

VI.e Fat/oil embolism - The FES embolism syndrome

1

VI.ad Right ventricular outflow tract compression

1

VII.c Mediastinal lipomatosis

4

VII.g Hemomediastinum - Mediastinal hematoma

1

VII.h Pneumomediastinum

-

VII.j Compression of mediastinal structures/organs

1

VIII.g Tracheal narrowing - Sabre sheath trachea

-

IX.a Diaphragm/inspiratory muscle weakness/paralysis (w/wo ARF)

4

IX.f Hiccup

2

IX.m Epidural thoracic lipomatosis

1

IX.p Disordered breathing during sleep - Sleep apnea

1

IX.v Generalized myopathy/muscle weakness

3

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

2

X.n Tumor lysis syndrome (TLS)

1

X.as Scleroderma renal crisis

2

X.ba Rhabdomyolysis (see also under Xj)

1

XI.v Rib fracture

1

XI.ag Vertebral compression fracture

4

XI.ai Cushing syndrome

5

XI.at Diminished efficacy of antineoplastic immunotherapy

2

XII.a Left or biventricular dysfunction/failure

2

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

1

XII.v Hypertrophic cardiomyopathy

2

XVI.at Imaging: Subpleural fat deposits

1

XVI.au Imaging: Mediastinal fatty deposits

4

XVII.a Respiratory tract infection incl. pneumonia

1

XVII.b Opportunistic pulmonary/systemic infections

5

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

3

XVII.d Pneumocystis jiroveci pulmonary colonization

3

XVII.e Pneumocystis jiroveci pneumonia

4

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

3

XVII.j Mucormycosis (pulmonary, tracheobronchial or systemic)

2

XVII.m Fungal airway infection

1

XVII.o Nocardia pulmonary/systemic infection

2

XVII.r Fungal infection (pulmonary/extrapulmonary)

4

XVII.v Strongyloides stercoralis hyperinfection (w/wo DAH)

2

XVII.w Hypogammaglobulinemia - Antibody deficiency

1

XVII.ai A falsely negative/indeterminate IGRA test result

2

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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