Pneumotox » Drug » BCG therapy (topical instillations in the urinary bladder)

BCG therapy (topical instillations in the urinary bladder)

PMID 26077036, 30526332

Last update : 27/03/2022

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

I.b Pneumonitis (ILD)

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.l Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf)

I.m ILD with a granulomatous component

II.b ARDS - Acute lung injury

IV.d Cough (lone)

V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

VII.a Lymphadenopathy (intrathoracic)

VII.e Granulomatous mediastinal lymphadenopathy

VIII.c Upper airway obstruction other than angioedema or hematoma

IX.r Myasthenia gravis - Myasthenic-like syndrome

IX.ab Guillain-Barré (or GB-like) syndrome (w/wo ARF)

X.g Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)

X.l Systemic granulomatosis other than Xk

X.m Vascultis (pulmonary, extrathoracic or systemic)-ANCA status unknown or negative)

X.u Multiple organ dysfunction/failure (MODS/MOF)

XV.e Path: ILD with a granulomatous component (see also Im)

XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

XV.ba Path: Granulomatous lymphadenopathy

XV.cg Path: Granulomatous hepatitis

XVI.u Imaging: A miliary pattern (diffuse random micronodules)

XVI.ai Imaging: A 'tree-in-bud' pattern

XVII.f Tuberculosis, miliary

XVII.i Mycobacterium bovis/BCG infection

XIX.a BAL: An excess proportion of lymphocytes

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