Chest
Volume 99, Issue 1, January 1991, Pages 98-104
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Bronchoalveolar Lavage Cell Data in 19 Patients with Drug-Associated Pneumonitis (Except Amiodarone)

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We examined bronchoalveolar lavage (BAL) cell data from 19 patients with a lung disorder presenting clinical, radiologic, functional, and course characteristics of drug-associated interstitial pneumonitis. In each of them, one of 13 different drugs was incriminated and no other cause was found. In one case due to bleomycin, a neutrophil and eosinophil alveolitis was present. In the other 18, the common denominator was a lymphocyte alveolitis, either pure (n = 6) or associated with neutrophilia (n = 5), eosinophilia (n = 3), or neutrophilia and eosinophilia (n = 4). In addition, in all patients, an inverted CD4/CD8 lymphocyte ratio was observed. In eight patients who underwent another BAL, lymphocyte alveolitis decreased but was persistent in two of them two to four months after cessation of treatment with the drug incriminated, whereas interstitial pneumonitis had resolved clinically. In five patients, after resolution of pneumonitis and after an almost normal BAL cell profile was obtained, resumption of treatment with the suspected drug for two to four weeks induced a rise in lymphocyte population in a third BAL. In conclusion, apart from one case of bleomycin lung, the most striking feature of drug-associated alveolitis in this series was expansion of lymphocyte population and imbalance in lymphocyte subsets. When a provocation test was performed, variations in alveolar lymphocyte levels paralleled withdrawal and readministration of the drug responsible for alveolitis. These data could be of value in diagnosing and understanding drug-induced lung disorders. (Chest 1991; 99:98–104)

Section snippets

Study Populations

Diagnosis of drug-associated pneumonitis was established by the following criteria. (1) Patients had been receiving drug treatment on a more or less long-term basis prior to the onset of lung disorders (Table 1). (2) New bilateral infiltrates appeared on chest roentgenogram. (3) There was no exposure to environmental agents known to be liable to induce lung disorders. (4) No other cause of interstitial pneumonitis was found after repeated clinical and biologic tests. Examination of sputum and

BAL Cell Abnormalities at Hospital Admission

Table 2 shows BAL cell individual data from our 19 patients. When compared with data from healthy subjects, total cell count was almost normal and macrophage count mean value was normal in absolute number and lower in proportion, given the increase in other cell types. When calculated in proportion as well as in absolute number, mean values of lymphocytes and neutrophils were found higher than those from controls, whereas the rise in eosinophil mean value was present in proportion, although it

DISCUSSION

In this series of 19 cases, 13 drugs listed in Table 1 were likely to be responsible for pneumonitis.

In the literature,6 pulmonary toxicity due to five of the 13 drugs incriminated (bleomycin, methotrexate, nitrofurantoin, gold salts, and nilutamide) has already been mentioned in 26 BAL-investigated cases (Table 4). We present herein data about BAL from nine patients with pneumonitis associated with one of these five drugs; six of these nine cases have been published previously.7, 8, 9, 10

In

ACKNOWLEDGMENTS

We are grateful to Els Cauverien for helpful discussion and Martine Dabancourt for secretarial assistance.

References (0)

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