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Saito K, Gemma A, Tatsumi K, Hattori N, Ushiki A, Tsushima K, Saito Y, Abe M, Horimasu Y, Kashiwada T, Mori K, Sato M, Nishiya T, Takamatsu K, Sun Y, Arakawa N, Izumi T, Ohno Y, Saito Y, Hanaoka M. Identification and characterization of lysophosphatidylcholine 14:0 as a biomarker for drug-induced lung disease. Sci Rep 2022; 12:19819. [PMID: 36396675 PMCID: PMC9671920 DOI: 10.1038/s41598-022-24406-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Drug-induced interstitial lung disease (DILD) occurs when drug exposure causes inflammation of the lung interstitium. DILD can be caused by different types of drugs, and some DILD patterns results in a high mortality rate; hence, DILD poses a serious problem in clinical practice as well as drug development, and strategies to diagnose and distinguish DILD from other lung diseases are necessary. We aimed to identify novel biomarkers for DILD by performing lipidomics analysis on plasma samples from patients with acute and recovery phase DILD. Having identified lysophosphatidylcholines (LPCs) as candidate biomarkers for DILD, we determined their concentrations using validated liquid chromatography/mass spectrometry biomarker assays. In addition, we evaluated the ability of LPCs to discriminate patients with acute phase DILD from those with recovery phase DILD, DILD-tolerant, or other lung diseases, and characterized their association with clinical characteristics. Lipidomics analysis revealed a clear decrease in LPC concentrations in the plasma of patients with acute phase DILD. In particular, LPC(14:0) had the highest discriminative index against recovery phase and DILD-tolerant patients. LPC(14:0) displayed no clear association with causal drugs, or subjects' backgrounds, but was associated with disease severity. Furthermore, LPC(14:0) was able to discriminate between patients with DILD and other lung diseases, including idiopathic interstitial pneumonia and lung disease associated with connective tissue disease. LPC(14:0) is a promising biomarker for DILD that could improve the diagnosis of DILD and help to differentiate DILD from other lung diseases, such as idiopathic interstitial pneumonia and connective tissue disease.
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Affiliation(s)
- Kosuke Saito
- grid.410797.c0000 0001 2227 8773Division of Medical Safety Science, National Institute of Health Sciences, Kawasaki, 210-9501 Japan
| | - Akihiko Gemma
- grid.410821.e0000 0001 2173 8328Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603 Japan
| | - Koichiro Tatsumi
- grid.136304.30000 0004 0370 1101Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, 260-8677 Japan
| | - Noboru Hattori
- grid.470097.d0000 0004 0618 7953Department of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, 734-8551 Japan
| | - Atsuhito Ushiki
- grid.263518.b0000 0001 1507 4692First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, 390-8621 Japan
| | - Kenji Tsushima
- grid.410797.c0000 0001 2227 8773Division of Medical Safety Science, National Institute of Health Sciences, Kawasaki, 210-9501 Japan ,grid.411731.10000 0004 0531 3030School of Medicine, International University of Health and Welfare, Narita, 286-8686 Japan
| | - Yoshinobu Saito
- grid.410821.e0000 0001 2173 8328Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603 Japan
| | - Mitsuhiro Abe
- grid.136304.30000 0004 0370 1101Department of Respirology (B2), Graduate School of Medicine, Chiba University, Chiba, 260-8677 Japan
| | - Yasushi Horimasu
- grid.470097.d0000 0004 0618 7953Department of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, 734-8551 Japan
| | - Takeru Kashiwada
- grid.410821.e0000 0001 2173 8328Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603 Japan
| | - Kazuhiko Mori
- grid.410844.d0000 0004 4911 4738Daiichi Sankyo RD Novare Co., Ltd., Tokyo, 134-8630 Japan
| | - Motonobu Sato
- grid.418042.b0000 0004 1758 8699Astellas Pharma Inc., Tsukuba, 305-8585 Japan
| | - Takayoshi Nishiya
- grid.410844.d0000 0004 4911 4738Daiichi Sankyo RD Novare Co., Ltd., Tokyo, 134-8630 Japan
| | - Kazuhiko Takamatsu
- grid.418042.b0000 0004 1758 8699Astellas Pharma Inc., Tsukuba, 305-8585 Japan
| | - Yuchen Sun
- grid.410797.c0000 0001 2227 8773Division of Medical Safety Science, National Institute of Health Sciences, Kawasaki, 210-9501 Japan
| | - Noriaki Arakawa
- grid.410797.c0000 0001 2227 8773Division of Medical Safety Science, National Institute of Health Sciences, Kawasaki, 210-9501 Japan
| | - Takashi Izumi
- Kihara Memorial Foundation, Yokohama, 230-0045 Japan
| | - Yasuo Ohno
- Kihara Memorial Foundation, Yokohama, 230-0045 Japan
| | - Yoshiro Saito
- grid.410797.c0000 0001 2227 8773Division of Medical Safety Science, National Institute of Health Sciences, Kawasaki, 210-9501 Japan
| | - Masayuki Hanaoka
- grid.263518.b0000 0001 1507 4692First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, 390-8621 Japan
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COVID-19 Presentation and Outcomes among Cancer Patients: A Matched Case-Control Study. Cancers (Basel) 2021; 13:cancers13215283. [PMID: 34771446 PMCID: PMC8582532 DOI: 10.3390/cancers13215283] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Cancer patients have been described in previous studies as having a higher risk of contracting COVID-19 and a higher risk of developing a severe form of the disease. In this study, we compared a group of patients hospitalized for COVID-19 within the Lyon area with a matched group of patients free of cancer and also hospitalized for COVID-19. Cancer patients and control patients were matched in order to have a similar age, gender, and other preexisting conditions. In this study, the risk of death was higher among cancer patients, but the intensity of care was lower (lower access to intensive care unit, shorter length of stay). The risk of death among cancer patients appears to be mainly driven by the severity of the infection and therapeutic limitations decided at admission. Abstract It has been suggested that cancer patients are at higher risk of contracting COVID-19 and at higher risk of developing a severe form of the disease and fatality. This study’s objectives were to measure the excess risk of mortality and morbidity of patients with cancer among patients hospitalized for a SARS-CoV-2 infection, and to identify factors associated with the risk of death and morbidity among cancer patients. All first cancer patients hospitalized for COVID-19 in the two main hospitals of the Lyon area were included. These patients were matched based on age, gender, and comorbidities with non-cancer control patients. A total of 108 cancer patients and 193 control patients were included. The severity at admission and the symptoms were similar between the two groups. The risk of early death was higher among cancer patients, while the risk of intubation, number of days with oxygen, length of stay in ICU, and length of hospital stay were reduced. The main factors associated with early death among cancer patients was the severity of COVID-19 and the number of previous chemotherapy lines. The outcomes appear to be driven by the severity of the infection and therapeutic limitations decided at admission.
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Abstract
Pulmonary drug reactions are a relatively common factor causing interstitial pulmonary disease. Histological findings of pulmonary drug reactions can mimic other conditions such as various forms of idiopathic interstitial pneumonia such as nonspecific interstitial pneumonia, organizing pneumonia, diffuse alveolar damage, or usual interstitial pneumonia. The correct diagnosis is important since a causal therapy is possible by stopping the administration. A stringent correlation between dose/time of administration and the type of reaction exists for only a few drugs. An increased risk of drug side effects can arise from known reactions to that specific drug, the patient's history, the type of underlying disease, genetic polymorphisms, occupational factors, and interactions with other drugs. The identification of a pulmonary drug reaction is a difficult task that can often only be solved in an interdisciplinary manner, for which in rare cases a lung biopsy is necessary. Pathology then has to identify histomorphological reaction patterns to exclude other causes and correlate findings with clinical data. In most cases, however, the diagnosis of a drug reaction will be by exclusion.
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Cruz Castellanos P, Esteban I, Romera MD, de Castro Carpeño J. Toxicidad pulmonar con relación a terapia contra el receptor del factor epidérmico. OPEN RESPIRATORY ARCHIVES 2019. [DOI: 10.1016/j.opresp.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Komada F. [Analysis of Time-to-onset of Interstitial Lung Disease after the Administration of Small Molecule Molecularly-targeted Drugs]. YAKUGAKU ZASSHI 2018; 138:229-235. [PMID: 29386436 DOI: 10.1248/yakushi.17-00194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to investigate the time-to-onset of drug-induced interstitial lung disease (DILD) following the administration of small molecule molecularly-targeted drugs via the use of the spontaneous adverse reaction reporting system of the Japanese Adverse Drug Event Report database. DILD datasets for afatinib, alectinib, bortezomib, crizotinib, dasatinib, erlotinib, everolimus, gefitinib, imatinib, lapatinib, nilotinib, osimertinib, sorafenib, sunitinib, temsirolimus, and tofacitinib were used to calculate the median onset times of DILD and the Weibull distribution parameters, and to perform the hierarchical cluster analysis. The median onset times of DILD for afatinib, bortezomib, crizotinib, erlotinib, gefitinib, and nilotinib were within one month. The median onset times of DILD for dasatinib, everolimus, lapatinib, osimertinib, and temsirolimus ranged from 1 to 2 months. The median onset times of the DILD for alectinib, imatinib, and tofacitinib ranged from 2 to 3 months. The median onset times of the DILD for sunitinib and sorafenib ranged from 8 to 9 months. Weibull distributions for these drugs when using the cluster analysis showed that there were 4 clusters. Cluster 1 described a subgroup with early to later onset DILD and early failure type profiles or a random failure type profile. Cluster 2 exhibited early failure type profiles or a random failure type profile with early onset DILD. Cluster 3 exhibited a random failure type profile or wear out failure type profiles with later onset DILD. Cluster 4 exhibited an early failure type profile or a random failure type profile with the latest onset DILD.
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Affiliation(s)
- Fusao Komada
- Faculty of Pharmaceutical Sciences, Himeji Dokkyo University
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Abstract
A wide variety of insults can produce acute lung damage, inclusive of those that injure the lungs directly. The clinical syndrome of acute onset respiratory distress, dyspnea, and bilateral infiltrates is referred to as acute respiratory distress syndrome. The histologic counterpart of acute respiratory distress syndrome is diffuse alveolar damage, classically characterized by hyaline membranes. Other histologic features of acute lung injury include intraalveolar fibrin, organization, interstitial edema, and reactive pneumocytes. Diffuse alveolar damage and other histologic features of acute lung injury are nonspecific as to etiology, and once identified require the pathologist to search the biopsy for further features that may help identify a specific etiology. This chapter reviews the temporal sequence of acute lung injury and explores the large variety of specific etiologic causes with emphasis on helpful histologic features to identify.
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Yen HR, Lai WY, Muo CH, Sun MF. Characteristics of Traditional Chinese Medicine Use in Pediatric Cancer Patients: A Nationwide, Retrospective, Taiwanese-Registry, Population-Based Study. Integr Cancer Ther 2016; 16:147-155. [PMID: 27405933 PMCID: PMC5739125 DOI: 10.1177/1534735416659357] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Large-scale surveys of complementary traditional Chinese medicine (TCM) use in pediatric cancer patients are lacking. The aim of our study was to investigate the use of TCM in pediatric cancer patients. METHODS We analyzed cancer patients younger than 18 years (n = 12 965) who were registered in the National Health Insurance Research Database in Taiwan between 2001 and 2011. Patients were categorized into TCM or non-TCM users based on their use of TCM. RESULTS In Taiwan, 8086 (62.4%) children with cancer sought TCM treatment at some point. Children in older age groups, including school-aged children and adolescents, were more likely to use TCM. There was no significant difference in the distributions of gender and urbanization. The 3 most common diseases for which TCM users visited the clinic were neoplasm (33.2%), respiratory system disease (32.9%), and infectious disease (8.86%). The most commonly utilized TCM therapy was Chinese herbal remedies. Patients who had comorbid conditions such as allergic rhinitis, dyspepsia, disorders of menstruation, and disease of the musculoskeletal system and connective tissue tended to visit TCM clinics. CONCLUSIONS Adjunctive TCM use is not low in Taiwanese children with cancer. Further studies to investigate the efficacy and safety of TCM in children with cancer are warranted.
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Affiliation(s)
- Hung-Rong Yen
- 1 Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,2 School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wan-Yu Lai
- 1 Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsin Muo
- 3 Health Data Management Office, China Medical University Hospital, Taichung, Taiwan
| | - Mao-Feng Sun
- 1 Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,2 School of Chinese Medicine, China Medical University, Taichung, Taiwan
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Aakre BM, Efem RI, Wilson GA, Kor DJ, Eisenach JH. Postoperative acute respiratory distress syndrome in patients with previous exposure to bleomycin. Mayo Clin Proc 2014; 89:181-9. [PMID: 24485131 PMCID: PMC3987121 DOI: 10.1016/j.mayocp.2013.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/15/2013] [Accepted: 11/12/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the incidence and risk factors for postoperative acute respiratory distress syndrome (ARDS) in a large cohort of bleomycin-exposed patients undergoing surgery with general endotracheal anesthesia. PATIENTS AND METHODS From a Mayo Clinic cancer registry, we identified patients who had received systemic bleomycin and then underwent a major surgical procedure that required more than 1 hour of general anesthesia from January 1, 2000, through August 30, 2012. Heart, lung, and liver transplantations were excluded. Postoperative ARDS (within 7 days after surgery) was defined according to the Berlin criteria. RESULTS We identified 316 patients who underwent 541 major surgical procedures. Only 7 patients met the criteria for postoperative ARDS; all were white men, and 6 were current or former smokers. On univariate analysis, we observed an increased risk of postoperative ARDS in patients who were current or former smokers. Furthermore, significantly greater crystalloid and colloid administration was found in patients with postoperative ARDS. We also observed a trend toward longer surgical duration and red blood cell transfusion in patients with postoperative ARDS, although this finding was not significant. Intraoperative fraction of inspired oxygen was not associated with postoperative ARDS. In bleomycin-exposed patients, the incidence of postoperative ARDS after major surgery with general anesthesia is approximately 1.3% (95% CI, 0.6%-2.6%). For first major procedures after bleomycin therapy, the incidence is 1.9% (95% CI, 0.9%-4.1%). CONCLUSION The risk of postoperative ARDS in patients exposed to systemic bleomycin appears to be lower than expected. Smoking status may be an important factor that modifies the risk of postoperative ARDS in these patients.
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Affiliation(s)
| | - Richard I Efem
- Stony Brook University School of Medicine, Stony Brook, NY
| | | | - Daryl J Kor
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
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Schwaiblmair M, Behr W, Haeckel T, Märkl B, Foerg W, Berghaus T. Drug induced interstitial lung disease. Open Respir Med J 2012; 6:63-74. [PMID: 22896776 PMCID: PMC3415629 DOI: 10.2174/1874306401206010063] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/06/2012] [Accepted: 07/06/2012] [Indexed: 01/15/2023] Open
Abstract
With an increasing number of therapeutic drugs, the list of drugs that is responsible for severe pulmonary disease also grows. Many drugs have been associated with pulmonary complications of various types, including interstitial inflammation and fibrosis, bronchospasm, pulmonary edema, and pleural effusions. Drug-induced interstitial lung disease (DILD) can be caused by chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents. There are no distinct physiologic, radiographic or pathologic patterns of DILD, and the diagnosis is usually made when a patient with interstitial lung disease (ILD) is exposed to a medication known to result in lung disease. Other causes of ILD must be excluded. Treatment is avoidance of further exposure and systemic corticosteroids in patients with progressive or disabling disease.
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Affiliation(s)
- Martin Schwaiblmair
- Department of Internal Medicine I, Klinikum Augsburg, Ludwig-Maximilians-University of Munich, Germany
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Schwaiblmair M, Behr W, Foerg W, Berghaus T. Cytochrome P450 polymorphisms and drug-induced interstitial lung disease. Expert Opin Drug Metab Toxicol 2011; 7:1547-60. [DOI: 10.1517/17425255.2011.629185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Dhakal B, Singh V, Shrestha A, Rao A, Choong N. Pemetrexed induced pneumonitis. Clin Pract 2011; 1:e106. [PMID: 24765347 PMCID: PMC3981441 DOI: 10.4081/cp.2011.e106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 10/20/2011] [Accepted: 10/21/2011] [Indexed: 11/23/2022] Open
Abstract
Pemetrexed is an antifolate chemotherapy agent that is active in malignant mesothelioma and non-small cell lung cancer (NSCLC). Pneumonitis is a rare side effect of Pemetrexed. We report the case of 72-year-old female with metastatic poorly differentiated lung adenocarcinoma. She was placed on maintenance pemetrexed and developed gradual progressive dyspnea after first cycle of maintenance of pemextrexed. The computed tomography (CT) of the chest showed ground glass opacity in both lung fields. Transbronchial lung biopsy showed uniform interstitial widening by a cellular chronic infiltrate with areas of type II pneumocyte and exudation of pale eosinophilic edema fluid; features consistent with acute lung injury. Patient improved both clinically and radiological after stopping pemetrexed and starting prednisone. Although pemetrexed induced lung injury is relatively rare, with the increasing use of peme-trexed in first-line treatment and in maintenance therapy of non-small cell lung cancer, awareness of this potential adverse effects is important.
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Affiliation(s)
| | | | | | - Arjun Rao
- Medical College of Wisconsin, Milwaukee, USA
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Fernández AB, Karas RH, Alsheikh-Ali AA, Thompson PD. Statins and interstitial lung disease: a systematic review of the literature and of food and drug administration adverse event reports. Chest 2008; 134:824-830. [PMID: 18689579 DOI: 10.1378/chest.08-0943] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To systematically review all published case reports and the US Food and Drug Administration adverse event reporting (FDA-AER) database to examine the relationship between statins and interstitial lung disease (ILD). DATA SOURCES PubMed (1987 to September 2007) and the FDA-AER database (as of June 2007) were searched for reports of ILD in which a statin was listed as a causative suspect. REVIEW METHODS Two authors (one author for Pub Med cases and one for FDA-AER cases) independently abstracted patient data. Given the paucity of information, all case reports and case series in English and French were included. All adverse event reports from the FDA-AER database in which a statin was listed as causative suspect were included. RESULTS The literature search using PubMed yielded eight articles describing a total of 14 case reports of ILD in association with statin use. The FDA-AER system database contained 162 cases of reported statin-induced ILD as of June 2007. For every 10,000 reports of a statin-associated adverse event, approximately 1 to 40 reports were for ILD. CONCLUSIONS Statin-induced ILD is a possible newly recognized side effect of statin therapy. The mechanism of lung injury is not defined. The current review provides novel information from the FDA-AER that supports a possible, although unusual, pulmonary class effect of statins.
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Affiliation(s)
- Antonio B Fernández
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Richard H Karas
- Division of Cardiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Alawi A Alsheikh-Ali
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Paul D Thompson
- Division of Cardiology, The Henry Low Heart Center, Hartford Hospital, Hartford, CT.
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Abstract
Specific accumulation and biotransformation of drugs cause cell injury in the lung. Evoked mechanisms are oxidative injury, direct cytotoxic effects, intracellular deposition of phospholipids, and immune reaction. Individual susceptibility can be due to genetically determined metabolic idiosyncrasy or to immune-mediated hypersensitivity.
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Affiliation(s)
- Luc M Delaunois
- Division of Pneumology, Université Catholique de Louvain, Cliniques Universitaires de Mont-Godinne, Service de pneumologie, Avenue Therasse 1, B-5530 Yvoir, Belgium.
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Ryu JH, Olson EJ, Midthun DE, Swensen SJ. Diagnostic approach to the patient with diffuse lung disease. Mayo Clin Proc 2002; 77:1221-7; quiz 1227. [PMID: 12440558 DOI: 10.4065/77.11.1221] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Detecting diffuse lung infiltrates on chest radiography is a common clinical problem. Many diverse pathological processes can cause diffuse lung disease. The presentation of these diseases can vary from acute to chronic and includes a side array of radiological patterns that are optimally evaluated on high-resolution computed tomography of the chest. In diagnosing diffuse lung disease, it is helpful to focus on a few pivotal parameters to narrow the broad differential diagnosis. We describe the diagnostic approach to a patient with diffuse lung disease usingthe following key parameters: tempo of the pathological process, characteristics of the radiological pattern, and clinical context.
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Affiliation(s)
- Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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Cleverley JR, Screaton NJ, Hiorns MP, Flint JDA, Müller NL. Drug-induced lung disease: high-resolution CT and histological findings. Clin Radiol 2002; 57:292-9. [PMID: 12014876 DOI: 10.1053/crad.2001.0792] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To compare the parenchymal high-resolution computed tomography (HRCT) appearances with histological findings in patients with drug-induced lung disease and to determine the prognostic value of HRCT. MATERIALS AND METHODS Drug history, HRCT features, histological findings and outcome at 3 months in 20 patients with drug induced-lung disease were reviewed retrospectively. The HRCT images were assessed for the pattern and distribution of abnormalities and classified as most suggestive of interstitial pneumonitis/fibrosis, diffuse alveolar damage (DAD), organizing pneumonia (OP) reaction, or a hypersensitivity reaction. RESULTS On histopathological examination there were eight cases of interstitial pneumonitis/fibrosis, five of DAD, five of OP reactions, one of hypersensitivity reaction and one of pulmonary eosinophilia. The most common abnormalities on HRCT were ground-glass opacities (n = 17), consolidation (n = 14), interlobular septal thickening (n = 15) and centrilobular nodules (n = 8). HRCT interpretation and histological diagnosis were concordant in only nine (45%) of 20 patients. The pattern, distribution, and extent of HRCT abnormalities were of limited prognostic value: all eight patients with histological findings of OP, hypersensitivity reaction, or eosinophilic infiltrate improved on follow-up compared to only five of 13 patients with interstitial pneumonitis/fibrosis or DAD. CONCLUSION In many cases of drug-induced lung injury HRCT is of limited value in determining the histological pattern and prognosis.
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Affiliation(s)
- Joanne R Cleverley
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Fulgoni P, Zoia MC, Corsico A, Beccaria M, Georgiani G, Bossi G, Cerveri I. Lung function in survivors of childhood acute lymphoblastic leukemia. Chest 1999; 116:1163-7. [PMID: 10559071 DOI: 10.1378/chest.116.5.1163] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To evaluate lung function in patients cured from childhood acute lymphoblastic leukemia (ALL) with chemotherapy alone or plus bone marrow transplantation (BMT). Pulmonary toxicity is a well-recognized side effect of many ALL treatments. DESIGN Cross-sectional study conducted at least 3 years after cessation of therapy. SETTING Outpatient pneumology department of the University Hospital. PATIENTS Forty-four subjects (age range at observation, 6 to 23 years): 21 treated only with intensive Berlin-Frankfurt-Munster (BFM)-type chemotherapy for newly diagnosed ALL (group A), and 23 treated with chemotherapy plus BMT (group B). MEASUREMENTS A detailed history of smoking habit, respiratory symptoms, and diseases was recorded directly from the patients with the aid of their parents. A complete physical examination and lung function testing (lung volumes and diffusion capacity for carbon monoxide [DLCO]) were performed in all subjects. RESULTS No patient reported acute or chronic respiratory symptoms or diseases. In group A patients, lung function was in the normal range, except for three subjects in whom there was an isolated impairment of DLCO. In group B patients, lung function was markedly impaired, with more than half the patients having an abnormal DLCO. A statistically significant difference was found between the two groups for FVC (p = 0.022) and DLCO (p = 0.004). CONCLUSIONS Intensive, BFM-type frontline chemotherapy is not associated with late pulmonary dysfunction; however, retreatment including BMT can frequently injure the lung. Thus, in patients who undergo BMT and whose life expectancy is long, careful monitoring of lung function and counseling about avoiding additional lung risk factors is recommended.
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Affiliation(s)
- P Fulgoni
- Institute of Respiratory Diseases, IRCCS Policlinico "S. Matteo," University of Pavia, Italy
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