Amiodarone

Abstract

Acute interstitial pneumonitis: case report A 76-year-old man developed acute interstitial pneumonitis during treatment with amiodarone for atrial fibrillation with rapid ventricular response. The man was admitted to the hospital with cough and dyspnoea. He had permanent pacemaker implantation for sick sinus syndrome three weeks prior. He also had a history of chronic obstructive pulmonary disease and bronchiectasis. His post-operative course was complicated with atrial fibrillation with rapid ventricular response and received amiodarone 400mg twice daily [route not stated] following discharge. Eight days after the discharge, he developed cough and dyspnoea and chest X-ray revealed new bilateral pulmonary infiltrates. Treatment with levofloxacin [Levaquin] was initiated for suspected community-acquired pneumonia. Additionally, the man’s treatment with amiodarone was discontinued. A week later, he developed acute hypoxic respiratory failure and required high-flow nasal cannula oxygen therapy. His chest CT showed new, diffuse ground-glass opacities, interstitial thickening, and bilateral pleural effusions. He treated with empiric unspecified antibiotics, but showed no improvement after 3 days. Also, aggressive diuresis was initiated for suspected pulmonary oedema due to underlying diastolic dysfunction on transthoracic echo. Amiodarone-induced acute interstitial pneumonitis was accused. Hence, he received treatment with methylprednisolone and a rapid improvement was observed. Repeated CT revealed, reduced ground-glass opacities. Diagnostic flexible bronchoscopy and bronchoalveolar lavage were performed; all cultured tests were negative. However, cytology revealed foamy macrophages. Based on the findings a diagnosis of amiodarone-induced acute interstitial pneumonitis was confirmed. He was discharged on nasal cannula and continued with prednisone decreased dose.