[Drug-induced pleural pathology (excluding antineoplastic chemotherapy)]

Drug-induced pleural side effects are rare and not usually identified. They may be a fibrous thickening of the pleura or an effusion, generally associated with an interstitial pneumopathy. Sometimes the pleural fluid is clear, sometimes hemorrhagic, and of varied cytological composition. The effusion can be uni- or bilateral. In the majority of cases, the pleural involvement stops when the causative agent is withdrawn. The pathology is usually attributed to a hypersensitivity mechanism when the following drugs have been given: nitrofurantoin, salazopyrine, erythromycin, ampicillin, gold salts, phenytoin, methysergide, ergotamine and bromocriptine. Some pleural lesions resemble lupus (induced by beta-blockers, hydralazine or procainamide). Amiodarone can cause fibroses or effusions via a toxic or hypersensitivity mechanism. In some instances, the mechanism remains unknown (1 case with imipramine, 1 case of fibrosis with perhexiline, 1 case of effusion with ibuprofen, 4 cases of effusion induced by dandrolene).