Pulmonary fibrosis drug-induced

Direct entry of alumina adjuvants through the skin may occur by the use of therapeutic vaccines, with a resultant transient uptake of aluminium in the brain (Redhead et al., 1992). The injection of talc (magnesium silicate)-containing drugs intended for oral consumption has been shown to induce progressive pulmonary fibrosis in drug abusers (Pare etal., 1989). 

Oxidative stress reduces the rate of cell proliferation, and that occurring during chemotherapy may interfere with the cytotoxic effects of antineoplastic drugs, which depend on rapid proliferation of cancer cells for optimal activity. Antioxidants detoxify ROS and may enhance the anticancer effects of chemotherapy. For some supplements, activities beyond their antioxidant properties, such as inhibition of topoisomerase II or protein tyrosine kinases, may also contribute. ROS cause or contribute to certain side effects that are common to many anticancer drugs, such as gastrointestinal toxicity and muagenesis. ROS also contribute to side effects that occur only with individual agents, such as doxorubicin-induced cardiotoxicity, cisplatin-induced nephrotoxicity, and bleomycin-induced pulmonary fibrosis. Antioxidants can reduce or prevent many of these side effects, and for some supplements the protective effect results from activities other than their antioxidant properties. Certain side effects, however, such as alopecia and myelosuppression, are not prevented... 

A fairly strong and consistent association between exposure, primarily in occupational settings, to solvents (e.g. trichloroethylene) and scleroderma has been reported in numerous epidemiological studies (see chapter 8). Scleroderma-like diseases can also be induced by other chemical compounds, such as drugs (D Cruz, 2000) and silica ( Erasmus syndrome ). Workers exposed to vinyl chloride monomers exhibit clinical features that resemble systemic sclerosis, such as fibrotic skin lesions, pulmonary fibrosis, and skin capillary abnormalities. However, vinyl chloride disease also harbours several features that are clearly distinct from systemic sclerosis. After exposure is discontinued, skin lesions, capillary abnormalities, and acroosteolytic lesions revert to nearly normal (Haustein Ziegler, 1985). 

In a patient with nitrofurantoin-induced pulmonary toxicity, in whom high resolution CT scans initially showed a widespread reticular pattern and associated distortion of the lung parenchyma, thought to represent established and irreversible fibrosis, follow-up CT scans after withdrawal of the drug showed resolution of the pulmonary changes. 

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