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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
Mercaptopurine (6-mercaptopurine)
1
Last update :
19/08/2021
I - Interstitial/parenchymal lung disease
I.a
Pneumonitis (ILD), acute and/or severe (may cause ARDS)
1
I.g
Pulmonary fibrosis
1
I.l
Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf)
1
X - Systemic/Distant conditions, syndromes and reactions
X.g
Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)
1
XIII - Neoplastic conditions
XIII.b
Lymphoproliferative disease (pulmonary, endobronchial, endothoracic)
1
XVII - Infections & related conditions
XVII.q
Viral pneumonia
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
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