Pneumotox » Drug » Sulfasalazine

Sulfasalazine

Asulfadine, azulfidine, salazopyrine. Drug-induced involvement in inflammatory bowel disease is against the specific respiratory manifestations of UC and CD (PMID: 22958334; 24525506)

Last update : 05/07/2014

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

I.b Pneumonitis (ILD)

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

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

I.g Pulmonary fibrosis

I.m ILD with a granulomatous component

II.d Pulmonary edema, cardiogenic

IV.y Eosinophilic airway disease (asthma, bronchitis, bronchiolitis)

V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

V.b Eosinophilic pleural effusion

V.d Pleural/pericardial effusion, ANA positive (DI lupus)

V.m Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

VI.d Pulmonary vasculitis or capillaritis

VII.a Lymphadenopathy (intrathoracic)

X.a DRES syndrome - DRESS-like reaction

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

X.g Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)

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

X.s Vasculitis, pulmonary (w/wo AH), extrapulmonary, systemic: ANCA-positive

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

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

XI.c Pleuritic chest pain

XII.c Pericardial effusion (w/wo tamponade)

XII.d Myocarditis (can be fulminant)

XII.h Eosinophilic myocarditis

XIV.a Methemoglobinemia

XV.c Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

XV.e Path: ILD with a granulomatous component (see also Im)

XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

XV.k Path: Desquamative interstitial pneumonia (DIP-pattern)

XV.ac Path: Pulmonary vasculitis other than capillaritis

XVII.w Hypogammaglobulinemia - Antibody deficiency

XIX.a BAL: An excess proportion of lymphocytes

XIX.c BAL: An excess proportion of eosinophils

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