19th May 2025

Introduction

The lungs have a large contact surface area and act as a site of metabolism for certain drugs; drug-induced lung injury is therefore not uncommon. Of this large collection of diseases, drug-induced interstitial lung disease (DILD) is the most common manifestation of drug-induced lung injury. DILD is caused by a wide range of drugs. Its incidence, severity and underlying mechanisms are variable dependent on the causative drug. Often, the precise mechanism of DILD for a particular drug is unclear. DILD severity can range from relatively innocuous benign infiltrates to respiratory failure and acute respiratory distress syndrome. The pathologic, radiologic and physiologic changes seen in DILD are highly variable and non-specific, which can make it difficult to recognise. The most common causative drugs are anti-neoplastic agents, disease-modifying anti-rheumatic drugs, antibiotics, and anti-arrhythmic agents. The diagnosis of DILD should be made by exclusion. Re-challenge of the suspected causative agent is generally not advised due to the risk of harm. Treatment is cessation of the drug, avoidance of further exposure and in severe cases systemic glucocorticoid therapy should be considered.