Onset may be acute or sub acute in nature.
Diffuse alveolar disease may present with acute clinical changes and radiographic evidence of diffuse, bilateral airspace consolidation.
The brochoalveolar lavage in diffuse alveolar disease associated with high number of neutrophils.
Acute eosinophilic pneumonia is usually idiopathic, but may be related to minocycline exposure. Acute eosinophlic pneumonia associated with fever, ground glass infiltrates, and greater than 25% eosinophils on bronchoalveolar lavage.
The main findings of drug induced lung disease is a subacute clinical presentation, including a nonspecific interstitial pneumonia and cryptogenic organizing pneumonia.
Nonspecific interstitial pneumonia is characterized by patchy or diffuse, ground glass opacities with basal predominance on chest x-ray.
Nonspecific, interstitial pneumonia may develop chronic fibrosis and bronchiectasis.
Bronchoalveolar lavage in nonspecific intersttial pneumonia reveals lymphocytes.
Elevated levels of the eosinophils may be present, but not to the level of acute eosinophilic pneumonia.
Cryptogenic organizing pneumonia may also be a manifestation of this process.
Cryptogenic organizing pneumonia may show patchy, bilateral ground glass or passive fees, but often has associated consolidation.
Cryptogenic, organizing pneumonia tends to show infiltrates predominantly peripherally in the lower lobes with subpleural and peribronchial distribution.
Bronchial lavage in cryptogenic organizing pneumonia usually shows increased lymphocytes, and eosinophils and neutrophils.
May be associated with sulfasalazine and mesalamine with nonspecific interstitial pneumonia or cryptogenic organizing pneumonia..
Methotrexate can cause interstitial lung disease.