Pneumotox » Drug » Statins

Statins

5

(A.k.a. HMG-CoA reductase inhibitors). Convincing cases reports of ILD contrast with the lack of epidemiological evidence (PMID 17223772, 23299962). Cerivastatin was recalled/discontinued worldwide in 2001, due to rhabdomyolysis, a complication common to statins and some other lipid-lowering agents. A paper in 2024 from one center (PMID 38460070) blamed statins at the origin of 455 fibrotic ILD cases…

Last update : 16/03/2024

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

2

I.b Pneumonitis (ILD)

2

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

2

I.f Acute fibrinous organizing pneumonia (AFOP)

1

I.g Pulmonary fibrosis

1

I.u Relapsing or migrating pneumonitis/pneumonia (see also Id)

-

I.x Pleuroparenchymal fibroelastosis (PPFE)

-

I.ar The association of ILD and myositis

1

IV.d Cough (lone)

2

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

1

V.b Eosinophilic pleural effusion

1

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

1

V.h Chylothorax

1

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

1

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

1

IX.ac Myositis of the respiratory muscles (May lead to respiratory muscle paralysis)

1

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

1

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

2

X.ba Rhabdomyolysis (see also under Xj)

3

XI.b Chest pain (acute or subacute), lone or prominent

1

XII.ab Pericardial fat necrosis

1

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

1

XV.d Path: Acute fibrinous organizing pneumonia (AFOP-pattern) (see also If)

1

XV.h Path: NSIP-fibrotic pattern

1

XV.o Path: Endogenous lipoid pneumonia (phospholipidosis)

1

XV.ap Path: Pleuroparenchymal fibrosis/fibroelastosis (PPFE)

-

XV.co Path: Foamy inclusions in alveolar macrophages and/or in other lung cells

1

XVI.bx Imaging: Waxing and waning nodules

1

XIX.f BAL: Foamy macrophages

1

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

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

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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