A Case of Amiodarone Pulmonary Toxicity with Short-term Amiodarone Use

Abstract

This is the case of a 92-year-old female who was hospitalized one month prior to admission for symptomatic paroxysmal atrial fibrillation, requiring intravenous amiodarone. Following her previous admission, she was placed on one month of amiodarone 200 mg twice daily, with a one week transition to 200 mg daily. The patient subsequently developed progressive shortness of breath and dry cough over a period of several weeks. Initial imaging showed diffuse bilateral coarse patchy interstitial infiltration on chest X-ray and bibasilar pleural effusions and scattered bilateral opacities on CTA chest. In an elderly patient presenting with dyspnea and dry cough, as well as interstitial opacities on imaging, amiodarone pulmonary toxicity should be considered despite short-term low-dose use.

Variable radiographic and histologic presentations of amiodarone‐related interstitial lung disease and the importance of avoiding re‐exposure

“…Proposed mechanisms of alveolar epithelial injury (which elicits subsequent inflammatory reactions) include intracellular oxidative stress relating to the iodine‐moiety of amiodarone, impaired organelle functions and phospholipid metabolism due to the amphophilic structure of amiodarone, dysregulated autophagy, and epithelial apoptosis possibly mediated by angiotensin‐2 associated pathways. 1 , 4 , 5 , 6 , 7 Reported risk factors for developing amiodarone‐related pulmonary toxicity are advanced age (older than 60 years), coexisting heart failure, prolonged treatment (>6 months), high daily or accumulated dosage, and recent cardiac surgery or exposure to iodine‐containing contrast medium. 1 , 2 , 3 , 8 In retrospect, all three patients in this present case series were more than 60 years old and received amiodarone for more than 6 months when the ILD occurred.…”

Daño Colateral en el Tratamiento de Pacientes con COVID-19.

“…Dentro de los efectos tóxicos de la Amiodarona a nivel pulmonar, se incluyen el desarrollo de SDRA, neumonía organizada, fibrosis pulmonar, daño alveolar difuso, neumonitis, entre otros. 29, 30 Es un diagnóstico de exclusión, donde la tomografía computarizada de tórax es una herramienta útil para el diagnóstico. 31 Los hallazgos relacionados con la exposición a Amiodarona están bien definidos, e incluyen cambios pulmonares parenquimatosos, engrosamiento septal, fibrosis intersticial, opacidades intersticiales, alveolares y pleuroparenquimatosas.…”

“…31,32 La interrupción de la Amiodarona es el tratamiento primario. 29,30 Por otra parte, es importante recordar que dentro de las complicaciones del uso de amiodarona se encuentran: disfunción tiroidea como hipo o hipertiroidismo que se presenta hasta en el 20% de los pacientes; también, la toxicidad hepática puede presentarse hasta en un 25% de los pacientes, con aumento de aminotransferasas, Hepatitis, e incluso insuficiencia hepática. 27,29 Comentarios: El uso de Amiodarona debe ser estrictamente individualizado por la alta toxicidad pulmonar en pacientes afectos de esta enfermedad viral.…”

Nano drugs delivery system: A novel promise for the treatment of atrial fibrillation

“…Classic antiarrhythmic drug treatment not only has poor curative effects and a high recurrence rate, but will also inevitably produce toxic side effects after long-term use ( 38 , 39 ). Although there are various ablation strategies in the clinical practice of AF treatment, in general, neither endocardial catheter ablation nor surgical ablation has achieved satisfactory results in the success rate of AF elimination ( 3 , 40 – 45 ), and there is a significant learning curve; experienced medical centers are far more effective than those with fewer deployments ( 46 , 47 ).…”