Drug-induced bronchiolitis obliterans organizing pneumonia
Section snippets
Minocycline
In a 2001 report, a 39-year-old woman who was treated for acne with minocycline for 5 months developed a cough and chest radiographic infiltrates [5]. Bronchoalveolar lavage showed marked increased in lymphocytes; a transbronchial biopsy showed BOOP. The minocycline was stopped which resulted in a rapid remission without treatment. A previous report indicated a 20-year-old woman who was reated with minocycline for acne [6]. Three months later, she developed progressive shortness of breath, a
Bleomycin
Focal nodular BOOP of the idiopathic type occurs in about 5% of individuals who have BOOP. The focal type of BOOP also was reported in individuals who received bleomycin [11]. This report indicated three patients who received bleomycin for treatment of osteogenic sarcoma. The pulmonary lesions developed in these patients who had received less than 200 mg of bleomycin. The lesions were detected radiographically without major respiratory symptoms. The lung biopsies showed BOOP; none progressed to
Amiodarone
There have been many reports of amiodarone-related BOOP [13], [14], [15], [16], [17], [18], [19]. Amiodarone is used to treat supraventricular and ventricular arrhythmias and has a half-life of 30 to 90 days. Pulmonary toxicity was recognized in reports during the 1980s. The incidence seems to range from 5% to 10%. Frequently, this pulmonary toxicity is reflected in the BOOP lesion. The mechanisms that underlie the toxic effects of amiodarone on the lungs are complex and may involve direct
Gold
For several years, interstitial lung disorders have been reported in patients who have rheumatoid arthritis and received gold therapy. Costabel and his associates [20] cited seven reports of possible gold-related BOOP. One of these reports included a 49-year-old woman who had rheumatoid arthritis and was treated with 2 months of weekly, intramuscular gold injections; she developed dyspnea and cough and her chest radiograph showed nodular opacities and an air-bronchogram [21]. The patient also
Carbamazepine
A 2002 report indicated that a 72-year-old man was treated with carbamazepine for focal seizures and was admitted to the hospital 7 weeks later with fever, increasing breathlessness, nonproductive cough, and bilateral crackles [24]. The radiograph showed upper lobe consolidation and the transbronchial biopsy showed organizing tissue that was consistent with BOOP. He was treated successfully with prednisolone.
The interferons
A 2003 report indicated four patients who were treated with interferon (IFN)-γ for
Summary
Several medications have been associated with the development of the BOOP lesion. Often, symptoms include nonproductive cough and shortness of breath with bilateral crackles by examination. Occasionally, there is fever and rash, and, rarely, eosinophilia. The chest radiograph usually shows bilateral patchy infiltrates. In rare situations, the outcome is fatal, although cessation of the medication or treatment with corticosteroid therapy results in resolution of symptoms and radiographic
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