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Drug-induced pleural disease.

John T Huggins1, Steven A Sahn

  • 1Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, P.O. Box 250630, Charleston, SC 29425, USA. hugginjt@musc.edu

Clinics in Chest Medicine
|April 6, 2004
PubMed
Summary

Drug-induced pleural disease, though uncommon, can cause effusions or pain without lung infiltrates. Clinicians should consider drug withdrawal for unexplained exudative pleural effusions.

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Area of Science:

  • Pulmonology
  • Clinical Pharmacology

Background:

  • Drug-induced lung disease is more recognized than drug-induced pleural disease.
  • Pleural reactions to drugs, including effusions and thickening, can occur independently of parenchymal lung involvement.
  • The incidence of drug-induced pleuropulmonary toxicity is expected to rise with new drug approvals.

Purpose of the Study:

  • To increase clinician awareness of drug-induced pleural disease.
  • To highlight diagnostic clues for drug-related pleural reactions.
  • To suggest prompt management strategies for suspected drug-induced pleural effusions.

Main Methods:

  • Review of clinical presentations and diagnostic approaches for drug-induced pleural disease.
  • Emphasis on detailed drug history and temporal associations.
  • Consideration of pleural fluid analysis, including eosinophilia.

Main Results:

  • Drug-induced pleural reactions manifest as pleural effusions, thickening, or chest pain.
  • These reactions may be the sole manifestation of drug toxicity.
  • Pleural fluid eosinophilia and a clear temporal link to drug initiation are key indicators.

Conclusions:

  • Clinicians must consider drug-induced pleural disease in patients with unexplained pleural effusions.
  • A thorough drug history and assessment of the timing of symptom onset are crucial.
  • Withdrawing the suspected drug should be considered before extensive diagnostic workups for exudative pleural effusions.

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