Drug-induced pneumonitis in pediatric oncology.

A high index of suspicion for drug-induced lung disease should be maintained in children receiving anticancer therapy. Hypersensitivity pneumonitis due to methotrexate is the most common form. Other drugs, such as bleomycin and BCNU, have dose-dependent toxic effects responsible for pulmonary fibrosis, which can be precipitated by the concomitant use of radiation therapy, oxygen therapy, and/or other anticancer agents. Bronchoalveolar lavage rules out an opportunistic infection an may show a cell pattern suggestive of hypersensitivity pneumonitis or pulmonary fibrosis.