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Etanercept

For those ILD cases exposed to methotrexate concomitantly, drug causality assessment can be extremely difficult

Last update : 03/09/2013

I.b Pneumonitis (ILD)

I.d Organizing pneumonia pattern (an area or areas of consolidation on imaging)

I.g Pulmonary fibrosis

I.m ILD with a granulomatous component

I.q Pulmonary nodulosis

I.w Rapidly progressive ILD/pulmonary fibrosis (Hamman-Rich syndrome)

I.y Progression, acceleration or exacerbation of preexisting ILD/fibrosis

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

IV.a Bronchospasm - Wheezing - Asthma

V.d Pleural/pericardial effusion, ANA positive (DI lupus)

V.f Pneumothorax

V.m Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

VI.a Pulmonary embolism - Venous thrombosis/thromboembolism

VI.d Pulmonary vasculitis or capillaritis

VII.a Lymphadenopathy (intrathoracic)

VIII.a Angioedema (may cause UAO, asphyxia and death)

IX.q Obstructive sleep apnea

X.b Antiphospholipid antibodies w/wo the APL syndrome

X.d Lupus - Lupus syndrome (see also Vd)

X.e Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)

X.f Anaphylaxis-Anaphylactoid reaction (can be fatal)

X.j Myopathy-Myositis-Polymyositis (see also under Xba)

X.k Sarcoid-like granulomatosis (endo-/extrathoracic)

X.m Vascultis (pulmonary, extrathoracic or systemic)-ANCA status unknown or negative)

X.s Vasculitis, pulmonary (w/wo AH), extrapulmonary, systemic: ANCA-positive

X.ar Relapse/flare/onset of Crohn's disease

XI.ad Granulomas on tattoo edges

XII.d Myocarditis (can be fulminant)

XV.a Path: NSIP-cellular pattern (see also Ia, Ib)

XV.c Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

XV.e Path: ILD with a granulomatous component (see also Im)

XV.ba Path: Granulomatous lymphadenopathy

XVII.a Respiratory tract infection incl. pneumonia

XVII.b Opportunistic pulmonary/systemic infections

XVII.f Tuberculosis, miliary

XVII.g Tuberculosis (pulmonary, pulmonary, extrapulmonary or disseminated). Reactivation or de novo

XVII.h Nontuberculous pulmonary mycobacterial infection/superinfection

XVII.ab Protozoan infection (incl. leishmaniasis)

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France