Pneumotox » Drug » Carmustine (BCNU)

Carmustine (BCNU)

See under 'nitrosoureas' and all other nitrosoureas (suffix '-mustine') which may produce similar reactions as a class effect

Last update : 31/12/2013

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

I.b Pneumonitis (ILD)

I.g Pulmonary fibrosis

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

I.x Pleuroparenchymal fibroelastosis (PPFE)

I.ad Radiation recall pneumonitis

II.a Pulmonary edema, noncardiogenic (NCPE)

II.b ARDS - Acute lung injury

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

V.f Pneumothorax

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

V.ab Pneumothorax, bilateral

XII.c Pericardial effusion (w/wo tamponade)

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

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

XV.h Path: NSIP-fibrotic pattern

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

XV.ap Path: Pleuroparenchymal fibrosis/fibroelastosis (PPFE)

XVI.a Imaging: Diffuse haze

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

XVI.m Imaging: Interlobular septal thickening

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