Srpski arhiv za celokupno lekarstvo 2014 Volume 142, Issue 7-8, Pages: 480-483
https://doi.org/10.2298/SARH1408480V
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Amiodarone pulmonary toxicity: Case report
Vasić Nada (Clinical Center of Serbia, Belgrade)
Pešut Dragica (Clinical Center of Serbia, Clinic for Pulmology, Belgrade + School of Medicine, Belgrade)
Stević Ruža (School of Medicine, Belgrade + Clinical Center of Serbia, Center for Radiology and MRI, Belgrade)
Jovanović Dragana (Clinical Center of Serbia, Clinic for Pulmology, Belgrade + School of Medicine, Belgrade)
Radivojević Slaviša (Clinical Center of Serbia, Belgrade)
Introduction. Amiodarone, an antiarrhythmic drug, which contains iodine
compound, has a tendency to accumulate in some organs including the lungs.
This is age, drug dosage and therapy duration dependent. Case Outline. We
present a case of a 73-year-old man, a smoker, who was admitted as emergency
case due to severe dyspnea, tachypnea with signs of cyanosis and respiratory
insufficiency. Chest x-ray revealed bilateral diffuse pulmonary shadows in
the middle and upper parts of the lungs, similar to those in tuberculosis.
His illness history showed chronic obstructive pulmonary disease, arterial
hypertension, and atrial fibrillation which has been treated with amiodarone
for six years. Sputum smears were negative for mycobacteria, and by the
diagnostic elimination method for specific, non-specific and malignant
disease the diagnosis of amiodarone pulmonary toxicity was made. Fiberoptic
bronchoscopy and pathohistological findings of bronchiolitis obliterans
organizing pneumonia confirmed the diagnosis. As the first therapeutic
approach, amiodarone therapy was stopped. Then, systemic therapy with
methylprednisolone 21 (sodium succinate) 40 mg i.v. daily during the first
two weeks was initiated and continued with daily dose of methylprednisolone
30 mg orally during the next three months. The patient showed a marked
subjective improvement during the first week, which was followed by the
improvement of respiratory function and withdrawal of pulmonary changes with
complete radiographic and CT resolution after eight months. Conclusion.
Amiodarone pulmonary toxicity should be taken into consideration, especially
in elderly patients with respiratory symptoms and pulmonary changes, even if
only a low dose of amiodarone is administred over a longer time period.
Keywords: amiodarone, toxicity, lungs, diagnosis, atrial fibrillation, lung function