Pleural effusion drug-induced

A hemodialysis patient developed refractory pleural effusion with prolonged leukopenia and thrombocytopenia, and another developed sudden cyanotic dyspnea with subsequent death after G-CSF administration for drug-induced neutropenia (93). The authors suggested that hemodialysis patients receiving G-CSF may have an increased risk of adverse effects. 

Drugs may produce serious pulmonary toxicity as part of a more generalized disorder. The pleural thickening, effusions, and flbrosis that occur as an extension of the retroperitoneal flbrotic reactions of methysergide and practolol or as part of a drug-induced lupus syndrome are the most common examples (Table 29-8). 

Since interferons are almost always used in combination with ribavirin in patients with hepatitis C infection, it can be difficult to know whether adverse events, if drug-induced, are due to one or the other. In many cases authors do not even discuss this problem, often attributing the supposed adverse effects to the interferon. In some cases withdrawal of one of the agents can provide evidence, and in other cases there may be other clues. For example, in cases of skin pigmentation at the site of injection of interferons, the adverse effect may be presumed to be due to interferon [26 ], a type II between-the-eyes adverse effect [27 ]. In one case hemolytic anemia was attributed to interferon rather than ribavirin because the patient had previously taken a course of interferon without adverse effects [28" ] presumably the inference was that the patient had been sensitized by the previous course. A systematic review of cases in which the drugs were used together and individually can also yield useful information, as in the case of pneumonitis in patients being treated with interferon and ribavirin, attributed to interferon [29" ]. Similarly, in cases of ocular myasthenia [30" ], pleural effusion [31 ], and cataract [32" ] the interferon was blamed because no previous cases were found in association with ribavirin alone. In cases in which the adverse event persists... 

TABLE A5-8 Drugs That May Induce Pleural Effusions and Fibrosis ... 

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