Sertraline
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First report of pulmonary fibrosis: case report A 33-year-old man developed pulmonary fibrosis during sertraline therapy for chronic schizophrenia. The man, who had been receiving sertraline 50 mg/day and risperidone for 3 years, presented with severe respiratory failure after a 6-month history of progressive dyspnoea with dry cough. Arterial blood gas analysis revealed a PaO2 of 7.74kPa and a PaCO2 of 4.17kPa on room air. Physical examination showed fine bibasal crackles and finger clubbing. His ESR was 43 mm/hour and he had a rheumatoid factor ratio of 1:40. A high-resolution CT scan showed diffuse ground-glass attenuation with marked reticular changes, most prominent in the lower lobes. A broncho-alveolar lavage revealed 26% neutrophils and 7.7% eosinophils. Microscopy and culture of bronchial washings were negative for pathogenic microorganisms. A lung biopsy showed a pattern of fibrotic non-specific pneumonia with eosinophilic infiltration and occasional foci of organising pneumonia. He was diagnosed with druginduced pulmonary fibrosis. Sertraline and risperidone were stopped and replaced with haloperidol. The man also received IV methylprednisolone and cyclophosphamide, which were later switched to oral prednisolone and azathioprine. He gradually recovered despite an episode of left-sided pneumothorax. Four weeks after the antipsychotics were discontinued, he was ambulatory and his respiratory failure had resolved. Prednisolone was tapered over the next 12 months and was stopped. Three years after initial diagnosis, he was clinically stable on azathioprine alone. A follow-up CT scan showed persistent widespread interstitial fibrosis, but the ground-glass attenuation and patchy consolidation have resolved. Author comment: "So although it is impossible to rule out a role for risperidone in the development of fibrosis in our patient, sertraline would seem to be by far the likeliest causative agent." Thornton C, et al. Pulmonary fibrosis associated with psychotropic drug therapy: A case report. Journal of Medical Case Reports 3: Jan 2009. Available from: URL: 803008610 http://dx.doi.org/10.1186/1752-1947-3-126 - United Kingdom
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of pulmonary fibrosis associated with sertraline. The WHO ADR database contained four reports of pulmonary fibrosis associated with sertraline.
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Reactions 27 Mar 2010 No. 1294
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