The Spectrum of Drug-Induced Interstitial Lung Disease

  • Ankush Ratwani
  • Bhavik Gupta
  • Brian W. Stephenson
  • Haresh Mani
  • A. Whitney BrownEmail author
Interstitial Lung Disease (A Hajari Case, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Interstitial Lung Disease


Purpose of Review

Drug-induced interstitial lung disease (DI-ILD) is a very challenging topic both clinically and academically. With the advent of new immunotherapy and ever-growing arsenal of chemotherapeutic and biologic agents for a variety of conditions, it is paramount for the clinician to assess for the development of pulmonary toxicity before irreversible lung damage occurs. In this review, we have summarized the literature and describe the most commonly implicated agents and also describe new and rare causes of DI-ILD.

Recent Findings

Bleomycin and amiodarone remain the most frequent culprits of DI-ILD. Proteasome inhibitors have been observed to cause pulmonary toxicity in some patients. GM-CSF has also emerged as a cause of DI-ILD in recent years. Nitrofurantoin is commonly associated with DI-ILD in the class of antimicrobial agents, with both acute and chronic toxicity described. Anti-TNF drugs, in particular, etanercept and infliximab, are the overwhelming offenders among the biologic agents. In addition, methotrexate has been widely associated with lung injury, especially in those with underlying rheumatoid arthritis.


Over 300 drugs are known to be associated with DI-ILD, and risk factors for the development of DI-ILD are not well understood. Radiographic patterns and histological patterns do not correlate well, and the data on treatment response to glucocorticoid therapy remains variable. Early identification, removal of the offending agent, and elimination of other causes of lung injury remain paramount in the approach to DI-ILD.


Interstitial lung disease Drug-induced ILD DI-ILD Immunotherapy Chemotherapy 


Compliance with Ethical Standards

Conflict of Interest

Ankush Ratwani, Bhavik Gupta, Brian Stephenson, Haresh Mani, and A. Whitney Brown declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ankush Ratwani
    • 1
  • Bhavik Gupta
    • 1
  • Brian W. Stephenson
    • 2
  • Haresh Mani
    • 3
  • A. Whitney Brown
    • 4
    Email author
  1. 1.Department of Internal MedicineMedStar Georgetown University HospitalWashingtonUSA
  2. 2.Department of MedicineDuke Medical CenterDurhamUSA
  3. 3.Department of PathologyInova Fairfax HospitalFalls ChurchUSA
  4. 4.Inova Advanced Lung Disease and Transplant ProgramInova Fairfax HospitalFalls ChurchUSA

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