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Diagnosing DIRD
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The Drug-Induced Respiratory Disease Website
Philippe Camus, M.D.
Dijon, France
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Drugs
Patterns
Nasal decongestants
1
Last update :
09/11/2016
I - Interstitial/parenchymal lung disease
I.j
Exogenous lipoid pneumonia (subacute, acute)
1
VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.ak
Rhinitis medicamentosa
2
XV - Pathology
XV.p
Path: Exogenous lipoid pneumonia
1
XVI - Imaging
XVI.bl
Imaging: An area or areas of avid tracer uptake in the lung/chest on 18F-PET scan
1
XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA
XIX.h
BAL: Exogenous (oil red O-stainable) lipids in BAL macrophages
1
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Identify causative drugs
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
More detailed checklist
See also under
Oil-/lipid-based formulations (parenteral)
Paraffin-Vaseline-Oil-Lipids (Mineral or other) p.o./inhaled/aspirated
