Steroidrefraktäre Lungenfibrose durch Amiodaron: Klinik und Morphologie nach einem amiodaronfreien Intervall von 3 Monaten

Abstract

Amiodarone-induced bilateral diffuse pulmonary fibrosis developed in a 47-year-old woman with idiopathic hypertrophic subvalvular aortic stenosis who had been treated with amiodarone (Cordarex), 300 mg daily for about 18 months. Although the drug was discontinued and cortisone treatment begun, the pulmonary fibrosis did not regress. When gentamicin (Refobacin) and cefotaxime (Claforan) were administered for suspected fibrosis-induced right-sided bronchopneumonia, gentamicin-induced acute tubular renal damage occurred, requiring dialysis. The patient died soon after of myocardial electro-mechanical dissociation. At necropsy there was, in addition to the idiopathic hypertrophic subvalvular cardiomyopathy, extensive bilateral pulmonary fibrosis, lamellar bodies in foam-cell intraalveolar macrophages, in hepatocytes and in the epithelium of the proximal and distal tubules. Although amiodarone had been discontinued three months previously, high concentrations of the drug were still present, especially in both lungs, fat tissue and the liver.

Amiodarone-induced pulmonary toxicity with an excellent response to treatment: A case report

“…Amiodarone is a drug widely used in the treatment of cardiac arrhythmias, but sometimes it can cause side effects, interesting all the organs [1,2,8]. Pulmonary toxicity is less frequent than thyroid and eye involvement but is potentially the most dangerous event for the patient leading to respiratory failure or even death [[3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]]. Lung toxicities may occur both in acute and in subacute/chronic forms.…”

“…Pulmonary toxicity may initially progress despite drug stopping or even recur upon steroid withdrawal, probably for the long half-life of amiodarone. The clinical answer depends on the individual sensitivity to treatment and the prolonged persistence of the drug at high concentration in the lung tissue, even over 90 days [14].…”