Pneumotox » Drug » Penicillamine

Penicillamine

The cis or dextro isomer d-penicillamine

Last update : 12/10/2014

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

II.b ARDS - Acute lung injury

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

III.b Pneumorenal syndrome (w/wo ANCAs)

III.d Alveolar hemorrhage, diffuse (ANCA-positive/-related)

IV.a Bronchospasm - Wheezing - Asthma

IV.c Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx)

IV.n Obstructive airway dysfunction (see also IVc, XVx)

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

IX.a Diaphragm/inspiratory muscle weakness/paralysis (w/wo ARF)

IX.r Myasthenia gravis - Myasthenic-like syndrome

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

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

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

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

X.ac Anti-GBM antibody disease (Goodpasture-like or flare of preexisting GS)

XI.t Yellow nail syndrome

XV.z Path: Obliterative (constrictive) bronchiolitis (see also IVc, IVn)

XVII.w Hypogammaglobulinemia - Antibody deficiency

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