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Thalidomide

The drug was recalled in the 1960s on the basis of embryopathy and skeletal (limb) malformations. Thalidomide and congeners (lenalidomide, pomalidomide) are now used for the treatment of multiple myeloma

Last update : 25/10/2018

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)

II.b ARDS - Acute lung injury

VI.a Pulmonary embolism - Venous thrombosis/thromboembolism

VI.b Pulmonary arterial hypertension

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

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

XIX.a BAL: An excess proportion of lymphocytes

XIX.b BAL: An excess proportion of neutrophils

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