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The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France

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Trimethoprim sulfamethoxazole (TMP-SMX)

3
Last update : 22/03/2022
I - Interstitial/parenchymal lung disease

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

1

I.b Pneumonitis (ILD)

-

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

1

I.e Acute eosinophilic pneumonia (AEP)

1

I.f Acute fibrinous organizing pneumonia (AFOP)

1
II - Pulmonary edema - Acute lung injury - ARDS

II.a Pulmonary edema, noncardiogenic (NCPE)

1

II.b ARDS - Acute lung injury

1

II.u Acute respiratory failure (e.g. from ARDS, ILD, PIE, OP, pulmonary edema or bronchospasm) requiring ECMO

1
X - Systemic/Distant conditions, syndromes and reactions

X.a DRES syndrome - DRESS-like reaction

1

X.e Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)

1

X.f Anaphylaxis-Anaphylactoid reaction (can be fatal)

1

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

1

X.x Subclinical ANCA positivity

1
XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)

XIV.a Methemoglobinemia

1
XV - Pathology

XV.b Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)

1

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

2

XV.ct Path: Delayed alveolar injury with delayed epithelialization (DAIDE)

1
XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA

XIX.c BAL: An excess proportion of eosinophils

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
Sulfadoxine
1
Sulfamethoxypyridazine
1
Sulfamides - Sulfonamides
3
Sulfasalazine
3

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