Duloxetine Induced Interstitial Lung Disease – A Novel Case Report
Bibliographic record
Abstract
Abstract Introduction: Duloxetine is commonly prescribed as an antidepressant. Here, we report the first case of duloxetine-induced non-eosinophilic interstitial lung disease (ILD). Case Report: A 71-year-old female presented with a 1-month history of cough, yellow sputum, fever, vomiting, hyporexia, and 15-pound weight loss. A computed tomography pulmonary angiogram ruled out pulmonary embolism but revealed right upper lobe (RUL) consolidation and patchy consolidations/nodules in the right middle (RML) and lower lobes (RLL) (Figure 1-A). The respiratory virus panel, sputum and blood cultures, and Legionella urinary antigen were negative. She was hospitalized, treated with antibiotics, and referred to Respirology. At her clinic visit, she had dyspnea (Medical Research Council grade 2/5) and dry cough, with resolution of other symptoms. She reported exposure to foam and bamboo in her pillow and mattress but no exposure to chemicals, fumes, molds, or dusts. Her medications included duloxetine, simvastatin, omeprazole, levothyroxine, and bisoprolol. She had no connective tissue disease symptoms, and serology was negative. Examination showed SpO₂ at 97% on room air and bibasilar fine/coarse inspiratory crackles with fine crackles in the left mid-zone. Laboratory tests revealed leukocytosis (12.3 x10⁹/L), elevated CRP (114 mg/L), and ESR (73 mm/hr). Pulmonary function tests showed restriction (FVC 72%, TLC 56%) and reduced diffusing capacity (DLCO 48%). Follow-up chest CT showed resolution of RUL and RML consolidations and new consolidations in both lower lobes (LLL) (Figure 1-B). Migratory consolidations suggested organizing pneumonia (OP), from hypersensitivity pneumonitis (foam exposure), or (drug-induced) eosinophilic pneumonia (EP) due to duloxetine versus simvastatin. Bronchoalveolar lavage (BAL) from the LLL was negative for infections but showed neutrophilia (53%), eosinophilia (23%), and lymphocytosis (20%), suggesting EP and/or OP likely related to drug-induced ILD (DI-ILD). A second BAL with transbronchial lung biopsies showed mild neutrophilia (7%) and eosinophilia (4%), moderate numbers of intra-alveolar foamy macrophages and mild interstitial inflammation including lymphocytes and few eosinophils. Findings were not typical of either OP or EP. She was diagnosed with possible DI-ILD due to duloxetine that had been started a year prior, rather than due to simvastatin, which she had taken for many years; thus, duloxetine was discontinued. Following duloxetine discontinuation, she reported complete resolution of symptoms and chest CT showed complete resolution of abnormalities (Figure 1-C). Discussion: Duloxetine has only been associated with DI-ILD in one case report, diagnosed with eosinophilic pneumonia. We report here a case of non-eosinophilic DI-ILD due to duloxetine, which fully resolved after drug discontinuation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".