Amiodarone

Abstract

Organising pneumonia: case report A 79-year-old man developed organising pneumonia during treatment with amiodarone for atrial fibrillation. The man, who had chronic heart failure with reduced ejection fraction in postischaemic dilated cardiomyopathy, was admitted to hospital in the beginning of March 2020. He was experiencing dyspnoea, dry cough and signs of respiratory failure without fever from the ending of February 2020. His medical history was significant for implantable cardioverter-defibrillator for secondary prevention as he was affected by paroxysmal atrial fibrillation and ascending aortic aneurysm. He was free from any pulmonary history or any occupational exposure, and was a non-smoker. Eight months prior to the presentation, he had started receiving amiodarone with IV load followed by oral dose of 200mg three times daily which was deescalated to 200mg two times daily after 8 weeks. He received pantoprazole, atorvastatin, bisoprolol [bisoprolole], furosemide and apixaban concomitantly. Laboratory tests revealed normal WBC count with normal neutrophilic and lymphocyte ratio, and increased creatinine levels. High resolution computed tomography (HRCT) of chest revealed vast areas of bilateral parenchymal consolidation and ground glass opacities in the upper lung lobes, with prevalent perihilar distribution in the lower lobes with air bronchiologram. CT also revealed enlargement of mediastinal lymph nodes and pleural effusion, mostly on the left. Later, COVID-19 pneumonia was ruled out as two consecutive SARS-CoV-2 nasopharyngeal swabs were found to be negative at admission and 48 hours after admission. No signs of acute heart failure, pulmonary oedema or ascites were noted. Therefore, cardiogenic pulmonary oedema was also ruled out. Further laboratory evaluation ruled out other causes of interstitial pneumonia. After exclusion of other causes, on the basis of HRCT findings, amiodarone-induced organising pneumonia was suspected. The man’s treatment with amiodarone was stopped, and he started receiving treatment with prednisone. Subsequently, his clinical condition improved. Follow-up CT scans in May 2020 and June 2020 revealed an absorption stage with a partial resolution of organising pneumonia characterized by progressive reduction of the parenchymal consolidations of the upper lobes, with persisting ground glass areas, and with slight signs of retraction on the pleural sheets and bronchovascular structures. Bilateral pleural effusion was absent. Improvement in signs and symptoms of respiratory insufficiency was observed. Final diagnosis of amiodarone-induced organising pneumonia was made.