La Revue du praticien
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Drug-induced infiltrative lung disease may manifest as variable clinical radiological patterns, including subacute or chronic interstitial pneumonia, pulmonary fibrosis, eosinophilic pneumonia, organising pneumonia, pulmonary edema, or sarcoidosis. A large amount of drugs have been incriminated, including those used in cardiovascular diseases (amiodarone, statins and angiotensin converting enzyme inhibitors), antibiotics (minocycline, nitrofurantoin), most of anticancer drugs (and especially chemotherapy and chest radiation), treatment of rheumatoid arthritis, as well as more recent drugs. ⋯ The following steps are necessary: history and timing of drug exposure, clinical and imaging pattern, exclusion of other causes of infiltrative lung disease, improvement following drug discontinuation. Rechallenge, dangerous, is not recommended.
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Fibroblasts are key cells in the fibrotic process. Their profibrotic phenotype is influenced by the environment in which they operate, both extracellular matrix and mediators which they are exposed. The pharmacologic modulation of the fibroblast phenotype allows to identify potential therapeutic targets which might interrupt the vicious cycle of pulmonary fibrogenesis.