Pneumotox » Drug » Bleomycin

Bleomycin

5

Cases are still being reported. 2013 review on BPT can be found under PMID 23312772

Last update : 29/07/2015

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

3

I.b Pneumonitis (ILD)

4

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

1

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

1

I.f Acute fibrinous organizing pneumonia (AFOP)

1

I.g Pulmonary fibrosis

2

I.k Lung nodule or nodules

2

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

2

I.p Fatal pneumonitis (ILD)

2

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

3

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

2

II.b ARDS - Acute lung injury

3

II.u Acute respiratory failure (e.g. from ARDS, ILD, PIE, OP, pulmonary edema or bronchospasm) requiring ECMO

1

V.f Pneumothorax

1

V.p Pleuroparenchymal fibroelastosis (PPFE)

1

V.z Pneumothorax (associated or secondary to drug-induced ILD)

1

VI.c Pulmonary veno-occlusive disease

1

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

1

VII.e Granulomatous mediastinal lymphadenopathy

1

VII.h Pneumomediastinum

1

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

1

XI.c Pleuritic chest pain

1

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

1

XV.b Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)

1

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

1

XV.d Path: Acute fibrinous organizing pneumonia (AFOP-pattern) (see also If)

1

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

2

XV.h Path: NSIP-fibrotic pattern

1

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

1

XV.j Path: Pulmonary fibrosis (UIP-pattern)

1

XV.l Path: Pulmonary fibrosis (not otherwise specified or unclassifiable)

1

XV.ax Path: Focal organizing pneumonia

1

XV.be Path: Interstitial pulmonary edema

1

XV.bf Path: Pulmonary necrotizing granuloma or granulomas

1

XVI.a Imaging: Diffuse haze

2

XVI.b Imaging: Ground-glass opacities (GGO) / shadowing

3

XVI.e Imaging: Pulmonary opacities with a subpleural distribution

2

XVI.k Imaging: An area or areas of consolidation

2

XVI.w Imaging: Lung nodule or nodules

2

XVI.ab Imaging: Cavitating/cavitary lung nodule, mass or nodules (see also Iq, XIs, XIIi, XVIaa and XVIIp)

1

XVI.af Imaging: Lung cysts or bullae (see also XVI ah/bf)

1

XVI.bl Imaging: An area or areas of avid tracer uptake in the lung/chest on 18F-PET scan

1

XVIII.j Eye-catcher: Avid lung uptake on 18F-PET-CT

1

XIX.b BAL: An excess proportion of neutrophils

1

XXIV.a Veterinary: Pneumonitis - Interstitial lung disease

1

XXIV.b Veterinary: Pulmonary fibrosis

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

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