Interstitial pneumonitis

Non-dose-related adverse effects of sulfasalazine include rash, fever, or hepatotoxicity most commonly, as well as relatively uncommon but serious reactions such as bone marrow suppression, thrombocytopenia, pancreatitis, pneumonitis, interstitial nephritis, and hepatitis. 

In the hamster, multiple short-term intratracheal instillations of zirconium lactate produced lesions beginning with exudative pneumonia followed by pneumonitis (interstitial pneumonia) and foreign body granulomas. Electron microscope microprobe analysis demonstrated the metallic component of the instilled compound in membrane-bound cytoplasmic inclusions of macrophages (Leininger et al. 1977). 

Mineral Oil Hydraulic Fluids. Lipoid pneumonia with marked interstitial pneumonitis and pulmonary fibrosis was observed in a child accidentally ingesting a lethal dose of automotive transmission fluid (Perrot and Palmer 1992). Although the exact composition of the hydraulic fluid was not reported, it is assumed to be a mineral oil hydraulic fluid because automotive transmission fluids typically contain... 

Mineral Oil Hydraulic Fluids. Only one report was located regarding death in humans following exposure to mineral oil hydraulic fluids. A 14-month-old boy ingested 5-10 cc of a mineral oil hydraulic fluid and died 4 weeks later after developing pneumonia (Perrot and Palmer 1992). Postmortem analysis revealed edema, hemorrhages, and lipoid/oil droplets in the lungs. The attending physicians believed that the development of lipoid pneumonia with marked interstitial pneumonitis eventually led to death. 

Procarbazine -alkylating agent cell cycle independent -bone marrow suppression—prolonged -nausea and vomiting—severe tolerance often develops with repeated dosing -mucocutaneous effects (mucositis, stomatitis, diarrhea) -rash, hives, photosensitivity -interstitial pneumonitis -CNS toxicity—seizures, lethargy, headache, ataxia -flu-like syndrome -azoospermia and amenorrhea almost universal... 

I 12. The answer is b. (Hardman, pp 1264-1265J Dactinomycin s major toxicities include stomatitis, alopecia, and bone marrow depression. Bleomycin s toxicities include edema of the hands, alopecia, and stomatitis. Mitomycin causes marked bone marrow depression, renal toxicity, and interstitial pneumonitis. Plicamycin causes thrombocytopenia, leukopenia, liver toxicity, and hypocalcemia. The latter may be of use in the treatment of hypercalcemia. Doxorubicin causes cardiotoxicity, as well as alopecia and bone marrow depression. The cardiotoxicity has been linked to a lipid peroxidation within cardiac cells. 

The adverse effects of antiandrogens are gynecomastia, hot flushes, GI disturbances, liver function test abnormalities, and breast tenderness. GI disturbances consist of diarrhea for flutamide and bicalutamide and nausea or constipation for nilutamide. Flutamide is also associated with methemoglobinemia, whereas nilutamide causes visual disturbances (impaired dark adaptation), alcohol intolerance, and interstitial pneumonitis. 

Respiratory Effects. Pulmonary function tests were not affected in workers exposed to hexachloroethane for 5 weeks while wearing protective equipment (Selden et al. 1994). Acute exposure of rats to 5,900 ppm hexachloroethane (a combination of gaseous and microcrystalline material) resulted in interstitial pulmonary pneumonitis (Weeks et al. 1979). These pulmonary lesions were seen after a 14-day recovery period. The entrapment of solid hexachloroethane particles in the lungs could have contributed to the symptoms observed. 

In some animal species, the lung may be a target organ when inhalation exposure to chloroform is of intermediate duration. Interstitial pneumonitis was observed in male rats and rabbits exposed to 85 ppm and in female rabbits exposed to 25 ppm chloroform for 6 months (Torkelson et al. 1976). The NOAEL was 50 ppm for male rats and rabbits. No respiratory changes were reported in guinea pigs and dogs exposed to 85 and 25 ppm chloroform, respectively. 

In one case report a 37-year-old male maintenance fitter was accidentally exposed to a large cloud of hot acetic acid while disconnecting a pressurized pump. The patient suffered first-degree burns on the hands and face and developed progressive dyspnea. At 3 months there were persistent extensive crackles in the basal area of the lungs, widespread bronchial inflammatory changes, and diffuse moderate interstitial pneumonitis that promptly improved after treatment with corticosteroids and bronchodilators. 

Rajan KG, Davies BH Reversible airways obstruction and interstitial pneumonitis due to acetic acid. BrJ Ind Med 46 67-68, 1989... 

Concentrations near 30,000ppm were lethal to rats within 15 minutes toxic signs included loss of coordination and narcosis. This level of exposure produced pulmonary edema, and in cases of delayed deaths, there was interstitial pneumonitis. Concentrations as low as 3 000 ppm for 15 minutes produced light narcosis in rats. No toxic effects were observed in rats, rabbits, and dogs exposed 7 hours/day, 5 days/week for 14 weeks to... 

Inhalation of mercury vapor may produce a metal fume fever-like syndrome, including chills, nausea, general malaise, tighmess in the chest, and respiratory symptoms. High concentrations cause corrosive bronchitis and interstitial pneumonitis. In the most severe cases, the patient will succumb because of respiratory insufficiency. In one episode involving four workers, it was estimated that mercurial pneumonitis resulted from exposure for several hours to concentrations ranging between 1 and 3mg/m. ... 

Intratracheal administration to guinea pigs of 100 mg of tantalum oxide produced transient bronchitis, interstitial pneumonitis, and hyperemia, but it was not flbrogenic. There were some slight residual sequelae in the form of focal hypertrophic emphysema and organizing pneumonitis around metallic deposits, and there was slight epithelial hyperplasia in the... 

If a diagnosis of amiodarone-induced hypersensitivity pneumonitis is made, discontinue amiodarone and institute steroid treatment. If a diagnosis of amiodarone-induced interstitial/alveolar pneumonitis is made, institute steroid therapy and discontinue amiodarone or, at a minimum, reduce dosage. 

Interstitial lung disease Cases of interstitial lung disease (including pneumonitis. 

Puimonary disorders Dyspnea, pulmonary infiltrates, pneumonia, bronchiolitis obliterans, interstitial pneumonitis, and sarcoidosis, some resulting in respiratory failure and/or patient deaths, may be induced or aggravated by peginterferon alfa-2a or alpha interferon therapy. 

Attar EC, Ervin T, Janicek M, et al. Side effects of chemotherapy. Case 3. Acute interstitial pneumonitis related to gemcitabine. J Clin Oncol 2000 18(3) 697-698. 

Nitrofurantoin can cause nausea and vomiting, fever, rash, hypersensitivity pneumonitis. When given for long periods of time, nitrofurantoin can cause progressive pulmonary interstitial fibrosis. 

Pulmonary eosinophilic syndrome, characterized by extreme hypoxemia, eosinophilia, interstitial pneumonitis, hilar lymphadenopathy, and pleural effusions, can be severe and can occur with as little as 7 to 9 days of therapy with the tetracyclines. In severe cases steroid therapy is required, but the outcome following drug discontinuation is nearly always good. 

Potentially fatal pulmonary toxicity (hypersensitivity pneumonitis or interstitial/al-veolar pneumonitis) hepatotoxicity proarrhythmiceffects... 

Pulmonary fibrosis, interstitial pneumonitis, fibrosing alveolitis, pulmonary edema, and pneumonitis have been reported. 

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