Lung diseases in realation to medicines

Lung diseases connected with immunosuppression

Lung changes in immunosuppressed patients have become common in recent years, because of both increased use of advanced treatment with cytotoxic agents, and increased occurrence of HIV/AIDS. The radiological changes in the lungs in immunosuppressed patients are non-specific, but vary depending upon the type of the opportunistic infection. The lung opacities are either localized, and then unilateral, or they may be diffuse and then usually bilateral.

The localized unilateral opacity is chiefly caused by bacterial pneumonia, but may also be seen in fungal infections. The most common bacteria are pseudomonas and klebsiella. If the radiological changes are diffuse and bilateral, the most likely organism is pneumocystis carinii (Fig. 85 a, b, c). The opacities in the lungs with these infections appear as infiltrates, most often bilateral. The infiltrates have indistinct borders, and are of mixed alveolar and interstitial type. Progression in the course of days is often seen, causing involvement of most areas of both lungs. The radiological appearance is often identical with that seen with congestion/edema. However, air bronchogram is frequently seen.

Medically-induced pulmonary disease

Lung opacities are not infrequently caused by reaction to drugs. In principle, most of the lung changes caused by drugs and visible on a chest radiograph resemble the changes encountered with pneumonia. A review of some of the drugs that may cause lung changes is shown in Table 8.

Table 8. Drugs that may cause lung changes

Alf Kolbenstvedt, Arnulf Skjennald and Charles B. Higgins