Pneumotox » Drug » Infliximab

Infliximab

Hypesrentitivity infusion reactions are common (PMID 12818276). For those ILD cases exposed to methotrexate concomitantly, drug causality assessment in regards to infliximab is difficult.

Last update : 02/11/2014

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.b Pneumonitis (ILD)

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

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

I.e Acute eosinophilic pneumonia (AEP)

I.g Pulmonary fibrosis

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

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

II.b ARDS - Acute lung injury

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

IV.a Bronchospasm - Wheezing - Asthma

V.a Pleural effusion (uni- or bilateral) (May commpany ILDs)

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

VI.a Pulmonary embolism - Venous thrombosis/thromboembolism

VI.d Pulmonary vasculitis or capillaritis

X.a DRES syndrome - DRESS-like reaction

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.g Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)

X.h Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

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

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

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

X.ah Granulomatosis with polyangiitis (typically ANCA pos.) - GPA flare

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

XII.c Pericardial effusion (w/wo tamponade)

XII.d Myocarditis (can be fulminant)

XII.q Pericarditis (see also under XIIc)

XII.br Right ventricular thrombus/thrombosis

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

XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

XV.cs Path: Pleural granulomas

XVI.b Imaging: Ground-glass opacities (GGO) / shadowing

XVII.b Opportunistic pulmonary/systemic infections

XVII.c Aspergillosis, pulmonary (invasive, allergic [ABPA], or mycetoma)

XVII.d Pneumocystis jiroveci pulmonary colonization

XVII.e Pneumocystis jiroveci pneumonia

XVII.f Tuberculosis, miliary

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

XVII.h Nontuberculous pulmonary mycobacterial infection/superinfection

XVII.n Legionella pneumophila pneumonia

XVII.o Nocardia pulmonary/systemic infection

XVII.q Viral pneumonia

XVII.r Fungal infection (pulmonary/extrapulmonary)

XVII.y Cryptococcus pulmonary and/or systemic infection

XVII.z Histoplamosis (reactivation)

XVII.ac Actinomycosis

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