Introduction: Drug-induced interstitial lung disease (DI-ILD) comprise a rare and heterogeneous disease entity with gradually increasing incidence. Consensus management approaches are still lacking.

Aim: To present our experience on clinical, radiological findings and therapeutic approaches of DI-ILD.

Methods: Retrospective analysis of medical records of all patients with DI-ILD presented to our department between 01/08/2019 and 01/08/2022 was performed.

Result: DI-ILDs represented 3% of all ILD cases in our referral center. Twenty-five(n=25) patients were identified and analyzed [males: 64% (n=16), mean age±SD:70.7 ±9, mean FVC baseline±SD:84.4±21.3, mean monocyte count±SD:771.5±319.4]. Most frequently encountered drugs were amiodarone (n=8, 32%), nitrofurantoin(n=4, 16%), pembrolizumab (n=3, 12%), mesalazine(n=3, 12%) and methotrexate(n=2, 8%). The predominant radiological patterns were nonspecific interstitial pneumonia (NSIP) in 9 patients (36%), organizing pneumonia in 5 patients (20%), fibrotic NSIP in 4 patients(16%) and indeterminate fibrotic patterns in 3 patients(12%). BAL showed 25 [14-48] % lymphocytes, 18 [7-29] % PMN and 2 [0-6] % eosinophils. All infectious searches remained negative. Oral corticosteroids were administered in the majority of cases (60%, n=15), with no treatment (n=6, 24%), antifibrotics(n=3, 12%) and  mycophenolate mofetil (n=2, 8%) following.

Conclusion: DI-ILD is a diagnosis of exclusion requiring high index of suspicion. Timely identification and removal of the causative drug is critical to reduce the likelihood of permanent lung damage. Larger cohorts and registries to establish management algorithms are sorely needed.