Fibrosis — A Common Pathway to Organ Injury and Failure

To the Editor: In their review, Rockey et al. (March 19 issue) 1 do not include drugs as a possible trigger of lung and cardiac fibrosis. A well-recognized cause of pulmonary fibrosis is drugs — in particular, antineoplastic agents such as bleomycin, busulfan, cyclophosphamide, and carmustine. 2 Other drugs, such as nitrofurantoin, amiodarone, procainamide, flecainide, and penicillamine, have also been implicated. The prognosis in patients with fibrosis induced by alkylating agents is often poor, and the mortality rate is high. The changes in the lung include fibrosis of the alveolar septa and enlargement of the type II alveolar-lining cells. 2 Drug-induced pulmonary fibrosis . . .