This concerns a 57-year old man with bilateral lung infiltrates which have progrediated since may 1

Fråga: This concerns a 57-year old man with bilateral lung infiltrates which have progrediated since may 1985 when they were first detected. Considerable exercise-induced dyspnea and leukocytosis are also present. So far, the aetiology of the lung infiltrates has remained unclear. The patient has been treated for several years for hypertension with Ismelin (guanethidine), Hygroton K (chlortalidone) and Aptin (alprenolol).

Can these drugs cause pulmonary infiltration as a side-effect?

Sammanfattning: Slowly progrediating lung infiltrates have not been described as adverse reactions to either guanethidine, chlortalidone or alprenolol.

Svar: Slowly progrediating lung infiltrates have not been described as an adverse reaction to any of the drugs in question either in the standard literature or in the Medline database. Pulmonary fibrosis, preceeded by sclerosing peritonitis, has however been described as a delayed reaction to practolol (1). One fatal case with fibrosis developing 3 years after practolol withdrawal as well as 6 further cases with a mean interval of 9 months after drug withdrawal were reported. This reaction has however not been described with any other beta-blocker than practolol. Acute allergic interstitial pneumonitis with pulmonary oedema has been reported in 5 patients receiving hydrochlortiazides (2). These reactions were all acute, occurring within hours after drug intake and have neither been described with chlortalidone. Guanethidine treatment has not been associated with pulmonary side-effects. 1 Davies, Textbook of adverse drug reactions, 1981; 2nd ed: 2 Meyler/Herxheimer, Side effects of drugs, 1980; 9th ed: 353