sulindac and Lung-Diseases

The authors report ten cases of drug induced lung diseases, complicated by respiratory failure of whom five were attributed to cytotoxic drugs and five to non cytotoxic drugs. The drug induced lung disease presented as acute respiratory distress syndrome in two cases, alveolar interstitial lung disease in three cases, purely interstitial in five cases. There was acute respiratory failure (ARF) in eight cases and chronic respiratory failure (CRF) in two cases. Among the five patients admitted for cytotoxic drug induced lung disease and ARF, four recovered and one died of diffuse destructive pulmonary fibrosis. Among the five patients having non cytotoxic drug induced lung disease, three were in ARF and recovered. The other two had CRF and died of diffuse pulmonary fibrosis. The diagnostic of drug induced lung disease was established in each case with the chronology of the clinical events, the exclusion of other possible causes of the lung disease and the evolution after removal of the incriminated drug. Broncho-alveolar lavage (BAL) had a major diagnostic value. It was contraindicated by respiratory failure in five cases. The predominant alveolar cell type was lymphocyte (four cases), eosinophil (three cases) and neutrophil (one case), BAL was realized with a provocation test and demonstrated the pathogenic role of cyclothiazide in one case. No specific information was given by histology. The prognosis did not seem to be linked to the severity of the initial clinical picture, or to the nature of the underlying neoplastic disorder, but to the degree and evolution of the pulmonary fibrosis.

Topics: Adrenal Cortex Hormones; Adult; Aged; Amiodarone; Ampicillin; Antihypertensive Agents; Benzothiadiazines; Bleomycin; Bronchoalveolar Lavage Fluid; Cyclophosphamide; Diuretics; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Lung Diseases; Male; Methotrexate; Middle Aged; Phenytoin; Prognosis; Sodium Chloride Symporter Inhibitors; Sulindac; Thiamphenicol

Pulmonary infiltrates, cough, dyspnea, and fever developed in a 62-year-old woman with chronic degenerative arthritis who had been receiving sulindac therapy for six months. Her pulmonary signs and symptoms resolved upon withholding the drug. Inadvertent rechallenge resulted in rapid recurrence of respiratory symptoms and pulmonary infiltrates. This constellation of clinical findings provides strong evidence of isolated pulmonary reactions as a complication of sulindac therapy.

Topics: Drug Hypersensitivity; Female; Humans; Lung; Lung Diseases; Middle Aged; Radiography; Sulindac

ADRs in the elderly may present in an atypical manner. Atypical reactions are uncommon and usually cannot be anticipated from the chemical or pharmacologic properties of the drug. In many cases, you may find a careful and thorough drug history and knowledge of drug-related reactions more helpful than an array of laboratory data.

Topics: Acetazolamide; Aged; Anemia, Hemolytic; Bromocriptine; Captopril; Chlorpropamide; Cimetidine; Clonidine; Dienestrol; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Hydralazine; Lung Diseases; Male; Middle Aged; Nitrofurantoin; Pancreatitis; Papaverine; Peripheral Nervous System Diseases; Procainamide; Propranolol; Sulindac; Theophylline; Timolol