Exposure-interstitial lung disease
- Drugs/Iatrogenic
Amiodarone: interstitial pneumonitis ↔ org. PNA ↔ ARDS; Rx: d/c amio; steroids
Other drugs: nitrofurantoin, sulfonamides, inh, hydralazine
Chemo: bleomycin, busulfan, cyclophosphamide, MTX, immunotherapy, XRT
- Pneumoconioses (inorganic dusts) (NEJM 2000;342:406; Clin Chest Med 2004;25:467)
Coal worker’s: upper lobe coal macules; may progress to massive fibrosis
Silicosis: upper lobe opacities ± eggshell calcification of lymph nodes; ↑ risk of TB
Asbestosis: lower lobe fibrosis, calcified pleural plaques, DOE, dry cough, rales on exam. Asbestos exposure → pleural plaques, benign pleural effusion, diffuse pleural thickening, rounded atelectasis, mesothelioma, lung Ca (esp. in smokers)
Berylliosis: multisystemic granulomatous disease that mimics sarcoidosis
- Hypersensitivity pneumonitides (organic dusts): loose, noncaseating granulomas
Antigens: farmer’s lung (spores of thermophilic actinomyces); bird fancier’s lung (proteins from feathers and excreta of birds or down); humidifier lung (thermophilic bacteria)