Médecine pulmonaire et respiratoire

Amiodarone Pulmonary Toxicity: A Case Report and Review of the Literature

Abstract

Zaineb Shamim, Pooja R Sarkar and Murali G Krishna

Amiodarone, a common and efficacious antiarrhythmic agent, carries with it an array of serious side effects, most notably, amiodarone induced pulmonary toxicity, or APT. Patients typically present with dyspnea, and chest X-rays will show interstitial infiltrates. In severe cases, toxicity can lead to fibrosis and even respiratory failure. In this report, such effects are demonstrated based on the case of an 85 year old female who presented with multiple hospital admissions for multilobar pulmonary infiltrates and acute hypoxic respiratory failure, which did not respond to antibiotic therapy. She had, at the time of admission, been on amiodarone for over 2 years. The patient’s amiodarone was discontinued, and she was started on prednisone. The patient displayed a significant clinical and radiographic improvement within 4 weeks. In patients with pulmonary infiltrates of unclear etiology who are on amiodarone, APT should be considered in the differential diagnosis. At this time, no specific diagnostic test for APT exists, and therefore clinical management must rely on a combination of clues gleaned from the medical history, diagnostic imaging, and a systematic exclusion of other differential diagnoses. A high index of suspicion is required to make the diagnosis of amiodarone pulmonary toxicity.