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Suggest Treatment For Drug Induced Lung Injury

Posted on Mon, 5 Dec 2016

Question: How can a medication cause lung injury? Could a medication cause injury to the lungs that could cause shortness of breath and decreased DLCO but all other PFTs and CT scan be normal?

I had received iron infusions and began experiencing delayed shortness of breath. They had stopped the infusions for a month and I began to feel better. However, when they started another infusion I developed shortness of breath again and it never went away. They have done many tests and all that has come back abnormal was a reduced DLCO. I have a normal hemoglobin level. I had the iron infusions only because my ferritin was low. The hematologist said that in rare cases iron can cause fibrosis. However, my CT scan was normal. I never had issues with breathing prior to these infusions.

Answered by Dr. Drkaushal85 (5 hours later)

Brief Answer:
Drug induced lung injury will be definitely show on CT scan and PFT.

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
Some drugs do cause lung injury, most commonly by producing inflammation and fibrosis.
So these kind of injuries produce its effect on PFT (obstructive or restrictive or both) and CT (fibrosis, thickening, atelectesis etc).
So with normal CT and normal PFT (except low DLCO), possibility of drug (iron infusion) related lung injury is very less.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (18 minutes later)

What could cause an isolated DLCO? Also my RV was 70% of predicted but I don't know if that is significant at all

Answered by Dr. Drkaushal85 (2 minutes later)

Brief Answer:
May I ask you few more questions?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I need more information for this.
May I ask you few more questions?

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (11 minutes later)

yes

Answered by Dr. Drkaushal85 (24 minutes later)

Brief Answer:
Do you smoke?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
Thanks for your confirmation.
Please let me know
1. Do you smoke?
2. Do you have any lung disease in past?
3. Do you have any allergies like dust, mites, danders etc?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (9 hours later)

1. I do not smoke. I was a light smoker years ago for less than 3 years.
2. No history of lung disease
3. I do have allergies. I take medications. However, I have had this all of my life.

Could this be a vascular/blood flow problem? I seem to have the most difficulty when going up stairs and feel best when lying flat. They had checked me for pulmonary hypertension due to low DLCO, and exaggerated heart rate response with activity (going up stairs) and flat blood pressure response with exercise, but that was negative. ECHO was normal. My oxygen levels stay normal. It feels like I have to really put effort in to expand my lungs. I take a lot of deep breaths.

Answered by Dr. Drkaushal85 (13 hours later)

Brief Answer:
Do you have any kind of stress?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Valvular and septal heart defect can cause such symptoms. But you are having normal 2d echo, negative for Pulmonary hypertension. So no need to worry for heart or lung related diseases.
If all reports are normal, we have to rule out stress related causes.
So please let me know
1. Are you dealing with any stressor?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (31 minutes later)

Not really any stress. Plus this has been going on for over 1.5 years and it is consistent with certain activity.

One last question..
Are there any pulmonary conditions that causes someone to have to take deep breaths with exertion? I really feel like my lungs need extra force to expand or open up

Answered by Dr. Drkaushal85 (5 minutes later)

Brief Answer:
With all normal reports, no such condition is there.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
Well, with all normal reports, no such lung condition is causing these symptoms.
Sometimes obesity can be the cause. I forgot to ask you about your weight and height.
Please let me know your height and weight?
You might be having phobia about things like going upstairs or doing exertion.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (31 minutes later)

I'm 5'9 130 lbs

I have seen a psychiatrist multiple times a he says it is not a psychiatric issue and it must be a medical problem. No doctor has been able to figure it out. I is very frustrating but I have faith some doctor will figure it out. Im just not sure of what kind of doctor I should see next..

Answered by Dr. Drkaushal85 (13 minutes later)

Brief Answer:
Obesity is not an issue for you.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Well, you are not obese so obesity is not an issue for your symptoms.
My sympathy is with you. I know how frustrating it is. Better to avoid over thinking about this. Stay relaxed and calm.
With all normal medical reports, no need to worry for heart or lung related diseases.
Forget everything about this.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar