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Medikamentös induzierte Lungenerkrankungen

Drug-induced pulmonary diseases

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Zusammenfassung

Medikamente sind eine relativ häufige Ursache einer interstitiellen Lungenerkrankung. Eine medikamenteninduzierte Lungenschädigung kann dabei nahezu jedes morphologische Muster der bekannten interstitiellen Pneumonie, wie eine nichtspezifische interstitielle Pneumonie (NSIP), eine organisierende Pneumonie (OP), einen diffusen Alveolarschaden (DAD) oder eine gewöhnliche interstitielle Pneumonie (UIP) induzieren. Die Diagnose einer medikamenteninduzierten Lungenschädigung ist dabei von weitreichender Bedeutung, da sie eine kausale Therapie durch Absetzen der nebenwirkungsauslösenden Medikation erlaubt. Ein gesteigertes Risiko für eine Medikamentennebenwirkung kann durch vorhergehende Reaktionen auf das betreffende Medikament, Medikamenteninteraktionen, berufsbedingte Faktoren und genetische Polymorphismen entstehen. Die Identifikation einer pulmonalen Medikamentenreaktion stellt jedoch eine schwierige, häufig nur interdisziplinär zu lösende Aufgabe dar, zu der in seltenen Fällen auch die Durchführung einer Lungenbiopsie notwendig ist. In diesen Fällen ist es die Aufgabe des Pathologen, die vorliegenden Reaktionsmuster zu benennen und zu entscheiden, ob eine mögliche Medikamentenschädigung infrage kommt. In diesem Entscheidungsprozess ist ein medikamentös ausgelöster Lungenschaden immer eine Ausschlussdiagnose.

Abstract

Pulmonary drug reactions are relative common factors causing interstitial pulmonary diseases. Histological findings of pulmonary drug reactions can mimic various forms of idiopathic interstitial pneumonia, such as nonspecific interstitial pneumonia, organizing pneumonia, diffuse alveolar damage and common interstitial pneumonia. The correct diagnosis of drug-induced pulmonary injury is important as a causal therapy is possible by terminating the administration. A stringent correlation between dose and time of administration and the type of reaction only exists for a few drugs. Possible hints for an increased risk to develop a drug reaction are known reactions to that specific drug, the patient history, the type of underlying disease, genetic polymorphisms, occupational factors and interactions with other drugs. However, the identification of a certain drug as the cause of a pulmonary reaction can still be difficult in the individual case and may require great efforts sometimes even by taking a biopsy. The pathologist then has to describe the patterns of reactions, exclude other causes and correlate the findings with the clinical data. In most cases, however, the diagnosis of a drug reaction will be by exclusion.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. I. Bittmann gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Bittmann, I. Medikamentös induzierte Lungenerkrankungen. Pneumologe 12, 19–25 (2015). https://doi.org/10.1007/s10405-014-0806-8

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  • DOI: https://doi.org/10.1007/s10405-014-0806-8

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