Pulmonary alveolitis

Hemolytic anemia has been reported (SEDA-10, 79) (SEDA-12, 83). A high percentage of patients taking azapropazone had a positive direct Coombs test, but this did not persist after treatment had been stopped for several weeks (SEDA-12,83). Hemolytic anemia has also been described in combination with pulmonary alveolitis, which suggests an allergic or immune reaction (3). Photosensitivity is often reported 190 reports of photosensitivity were submitted to several national drugmonitoring centers in Europe in 1985 (SEDA-10, 79) (SEDA-12, 83). 

Fenbufen can cause a pulmonary alveolitis with rash, dry cough, breathlessness, fever, hypoxia, sometimes eosino-philia, and bilateral alveolar shadowing or infiltrates, which regress after withdrawal (SEDA-12, 85) (SEDA-13, 80) (SEDA-15,100). 

Pulmonary alveolitis, pancytopenia, cholestatic hepatitis, stomatitis, proctitis, skin rash, proteinuria, renal insufficiency (52) Cholestatic hepatitis with allergic pneumonitis (186)... 

Pulmonary Presant et al. (44 ) and Zyroff et al. (67 =0 methadone-induced pulmonary oedema Byers et al. (8 ) acute pulmonary alveolitis Grieble et al. (21 ) scopulariopsosis and hypersensitivity pneumonitis. 

A number of studies of the toxicity of zinc oxide/hexachloroethane smoke have been conducted (Brown et al. 1990 Karlsson et al. 1986 Marrs et al. 1983). These studies demonstrate that smoke exposure results in pulmonary inflammation and irritation. When male Porton Wistar rats were exposed to hexachloroethane/zinc oxide smoke for 60 minutes, the lungs showed pulmonary edema, alveolitis, and areas of macrophage infiltration 3 days later. At 14 days, there was interstitial fibrosis and macrophage infiltration. At 28 days, increased fibrosis and macrophage infiltration were noted. However, these same symptoms occurred when the animals inhaled zinc chloride there was no apparent synergism between the zinc chloride and residual hexachloroethane (Brown et al. 1990 Richard et al. 1989). This is consistent with the fact that smoke contains little hexachloroethane and the observation that acute exposure to 260 ppm hexachloroethane had no effects on the lungs of rats (Weeks et al. 1979). 

PULM pulmonary region (alveolated airways and alveoli). 

Serious, potentially fatal pulmonary toxicity (alveolitis, pulmonary fibrosis, pneumonitis, acute respiratory distress syndrome) may begin with progressive dyspnea and cough with crackles, decreased breath sounds, pleurisy, CH F, or hepatotoxicity. 

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

All isocyanates are known to cause pulmonary toxicity. Isocyanates are the most common causes of occupational asthma and have led to the development of immediate or late asthma among workers. Isocyanates have caused bronchitis, rhinitis, conjunctivitis, chronic obstructive lung disease, contact sensitivity, dermatitis, allergic alveolitis, and immunologic hemorrhagic pneumonitis.29... 

A 60-year-old woman with bipolar disorder since the age of 29 developed idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) after having taken lithium for 9 years (148). Whether lithium played a causal role is at best highly speculative. 

Respiratory toxicity Upper respiratory system (nose, pharynx, larynx, and trachea) and the lower respiratory system (bronchi, bronchioles, and lung alveoli) Pulmonary irritation Asthma/bronchitis Emphysema Allergic alveolitis Fibrotic lung disease Lung cancer... 

Lung. Amiodarone may cause pulmonary fibrosis. Sulphasalazine is associated with fibrosing alveolitis. 

Interstitial pulmonary disease (Ijmphocytic alveolitis and mild interstitial pulmonary fibrosis) has been reported in a 70-year-old woman with ulcerative colitis who had taken mesalazine 2.4 g/day for 3 months (42). Halving the dose of mesalazine to 1.2 g/day led to resolution of her lung disorder without relapse of ulcerative colitis. 

The commonest form of lung damage is an interstitial alveolitis, although pneumonitis and bronchiolitis obhter-ans have also been reported, as have sohtary localized fibrotic lesions, non-cardiac pulmonary edema, pleural effusions, acute respiratory failure, acute pleuritic chest pain, and adult respiratory distress syndrome (SEDA-17, 220) (SEDA-18, 201) (66-68). Amiodarone has also been reported to cause impairment of lung function, even in patients who do not develop pneumonitis (69), and preexisting impairment of lung function may constitute a contraindication to amiodarone. 

Two cases of alveolitis have been reported with captopril, one associated with eosinophilia (1) and the other with a lymphocytic pulmonary infiltrate (2). 

Pulmonary toxicity in the form of fibrosing alveolitis has been attributed to fluorouracil. 

Acute febrile interstitial pneumonitis occurred within less than 48 hours after the second to fourth cycles of chemotherapy (doxorubicin, cyclophosphamide, bleomycin, methotrexate, plus methylprednisolone) in five patients with non-Hodgkin s lymphoma who were receiving prophylactic G-CSF n — 3) or GM-CSF (n = 2) (23). Lymphocytic alveolitis was confirmed in four of these patients and all three patients tested had an increased number of CD8+ T cells. Even though all the patients received high-dose methylprednisolone, two died as a result of diffuse and extensive interstitial pulmonary fibrosis, demonstrated at postmortem. Although both G-CSF and GM-CSF can cause acute pneumonitis in patients with cancers, it is still unknown to what extent hemopoietic growth factors are involved in this complication. 

Hallgren, R, Bjermer, L., Lundgren, R and Venge, P. (1989). Tho eosinophil component of the alveolitis in idiopathic pulmonary fibrosis. Signs of eosinophil activation in the lung are related to impaired lung functions. Am. Rev. Respir. Dis. 139, 373-377. 

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