Pulmonary diseases associated with immunomodulatory agents

Drug class	Drug	Complications
TNF-alpha inhibitors	Etanercept	Infectious
		Streptococcus pneumoniae
		Histoplasmosis
		Tuberculosis
		Noninfectious
		Systemic lupus erythematosus pleural disease
		Pulmonary fibrosis
		Granulomatous inflammation
		Pneumonitis
		Exacerbation of interstitial disease
	Infliximab	Infectious
		Tuberculosis
		Bovine tuberculosis
		Cryptococcosis
		Histoplasmosis
		Legionellosis
		Invasive and allergic aspergillosis
		Scedosporium infection
		Actinomycosis
		Pneumocystis jirovecii
		Coccidioidomycosis
		Noninfectious
		Langerhans cell histiocytosis
		Drug-induced alveolitis
		Systemic lupus erythematosus pleural or parenchymal disease
		Sarcoidosis
		Interstitial pneumonitis
		Diffuse alveolar hemorrhage
		Fibrosing alveolitis
	Adalimumab	Infectious
		Tuberculosis
		Aspergillosis
		Noninfectious
		Pulmonary fibrosis
IL-1 inhibitor	Anakinra	Infectious
IL-1 inhibitor	Anakinra	Tuberculosis
Costimulation blockade	Abatacept	Infectious
Costimulation blockade	Abatacept	Bacterial pneumonia
B-cell depletion	Rituximab	Noninfectious
		Interstitial pneumonitis
		Pulmonary fibrosis

TNF-alpha: tumor necrosis factor-alpha; IL-1: interleukin-1.

Data from:

Wood KL, Hage CA, Knox KS, et al. Histoplasmosis after treatment with anti-tumor necrosis factor alpha therapy. Am J Respir Crit Care Med 2003; 167:1279.
Abunasser J, Forouhar FA, Metersky ML. Etanercept-induced lupus erythematosis presenting as a unilateral pleural effusion. Chest 2008; 134:850.
Judson MA. Allergic bronchopulmonary aspergillosis after infliximab therapy for sarcoidosis: a potential mechanism related to T-helper cell cytokine balance. Chest 2009; 135:1358.
Larsen MV, Sorensen IJ, Thomsen VO, Ravn P. Re-activation of bovine tuberculosis in a patient treated with infliximab. Eur Respir J 2008; 32:229.
Dweik M, Baethge BA, Duarte AG. Coccidioidomycosis pneumonia in a nonendemic area associated with infliximab. South Med J 2007; 100:517.
O'Shea FD, Marras TK, Inman RD. Pulmonary sarcoidosis developing during infliximab therapy. Arthritis Rheum 2006; 55:978.
Villeneuve E, St-Pierre A, Haraoui B. Interstitial pneumonitis associated with infliximab therapy. J Rheumatol 2006; 33:1189.
Hage CA, Wood KL, Winer-Muram HT, et al. Pulmonary cryptococcosis after initiation of anti-tumor necrosis factor-alpha therapy. Chest 2003; 124:2395.
De Rosa FG, Shaz D, Campagna AC, et al. Invasive pulmonary aspergillosis soon after therapy with infliximab, a tumor necrosis factor-alpha-neutralizing antibody: a possible healthcare-associated case? Infect Control Hosp Epidemiol 2003; 24:477.
Allanore Y, Devos Francosis G, Caramella C, et al. Fatal exacerbation of fibrosing alveolitis associated with systemic sclerosis in a patient treated with adalimumab. Ann Rheum Dis 2006; 65:834.
Bitzan M, Anselmo M, Carpineta L. Rituximab (B-cell depleting antibody) associated with lung injury (RALI): a pediatric case and systematic review of the literature. Pediatr Pulmonal 2009; 44:922.
Wagner SA, Mehta AC, Laber DA. Rituximab-induced interstitial lung disease. Am J Hematol 2007; 82:916.
Biehn SE, Kirk D, Rivera MP, et al. Bronchioltis obliterans with organizing pneumonia after rituximab therapy for non-Hodgkins lymphoma. Hematol Oncol 2006; 24:234.
Kuru T, Lynch LP 3rd. Nonresolving or slowly resolving pneumonia. Clin Chest Med 1999; 20:623.

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Pulmonary diseases associated with immunomodulatory agents