Pneumonitis (ILD, subacute)

Or 'ILD'. (Fr: PnP subaiguë). A.k.a. pulmonary infiltrates. Generally bilateral and symmetrical. Gradual onset. Consistent with but not specific for an NSIP-c pattern. Less dense, less severe and diffuse than pattern Ia. Also lacks the features of ARDS that may accompany pattern Ia. Can be in the form of disseminated linear, reticulonodular, miliary or patchy opacities. BAL is indicated to separate this pattern from PIE (Ic) or DAH (III-IIIa). A search for microorganisms including Pneumocystis (stains, PCR) is indicated. On pathology (although not many cases undergo a confirmatory lung biopsy), there is interstitial inflammation and a more or less dense cellular interstitial infiltrate (NSIP-c). Fibrosis, alveolar edema and/or a reactive epithelium denote those cases associated with antineoplastic chemotherapy. The frontier between patterns Ia and b can be difficult to draw, so please check drugs under Ia as well. Patients may shift from pattern Ib Ia particularly if the causal drug is inappropriately continued. Prompt withdrawal is indicated and often therapeutic, underlying disease permitting

Last update : 17/09/2016

Causative drugs