Drugs and the pleura

Purpose: To identify the drugs associated with pleural disease and to revie w the clinical, radiographic, and pleural fluid findings that occur, the na tural history of the pleural reaction, and the response to therapy, Data sources: English-language articles published from January 1966 through April 1998 were identified through searches of the MEDLINE database, selec tive bibliographies, and personal files. Data extraction: Case reports, letters, and review articles were assessed f or relevancy. Reports of drug-associated pleural effusion, pleuritis, and/o r pleural thickening were analyzed. Drug effect was believed to be causal w hen exposure induced pleural disease, when the pleural response remitted on discontinuation of the drug, and when the pleural disease recurred with re exposure. Drug association was inferred when the pleural disease occurred f ollowing drug exposure and remitted after drug discontinuation. The inciden ce, clinical presentation, dose and duration of drug therapy, chest radiogr aphic findings, pleural fluid analysis, and response to therapy were record ed. Conclusions: A relatively small number of drugs were found to induce pleura l disease when compared to the number of drugs implicated. in causing disea se of the lung parenchyma, Treatment of drug-induced pleural disease consis ts of drug therapy withdrawal and corticosteroids for refractory cases. Kno wledge of the potential of drug-induced pleural disease will provide a clin ical advantage to the physician and. should lead to decreased morbidity and economic burden for the patient by avoidance of further diagnostic testing .