Ewha Med J.  2013 Sep;36(2):144-148. 10.12771/emj.2013.36.2.144.

Amiodarone-Induced Pulmonary Toxicity: Percutaneous Needle Aspiration Biopsy and Ultrastructural Findings

• Kang IS
• Lee JH
• Sung SH
• Park SH

• KMID: 2171250
• DOI: http://doi.org/10.12771/emj.2013.36.2.144

Abstract

Amiodarone has been widely used for supraventricular and ventricular arrhythmias and many patients benefit from its effectiveness in treating potentially life-threatening arrhythmias. However, this drug can cause multi-organ toxicity, including amiodarone-induced pulmonary toxicity (APT). Not only does amiodarone have a long half-life but also is lipophilic and therefore can easily accumulate in tissues. Hence, it is difficult to monitor therapeutic levels and side effects, making it difficult to predict toxicities. In this case, we describe multi-organ complications secondary to amiodarone use, especially APT combined with pneumonia with atypical pathogens and pulmonary hemorrhage. The patient reached a high cumulative dose of amiodarone despite a low maintenance dose of amiodarone. This case highlights an unusual presentation of APT with multi-organ toxicity and we review articles regarding the association between the cumulative dose of amiodarone and amiodarone-induced toxicities.

Keyword

Amiodarone; Lung, toxicity; Respiratory insufficiency

MeSH Terms

Amiodarone*
Arrhythmias, Cardiac
Biopsy, Needle*
Drug Toxicity*
Half-Life
Hemorrhage
Humans
Pneumonia
Respiratory Insufficiency
Amiodarone

Figure

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  Fig. 1 Chest X-ray showing new right upper lobe consolidation with reticulonodular opacities on both lung fields (A), when compared to a previous chest X-ray (B).

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  Fig. 2 Chest computed tomography scan showing subpleural consolidation with internal high attenuation (A), subpleural reticular opacity and interlobular septal thickening with patchy ground-glass opacities (B), and diffuse increase in the attenuation of the liver (C).

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  Fig. 3 Thyroid scan showing decreased 24-hour iodine uptake as 0.8%.

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  Fig. 4 Pathologic analysis of percutaneous needle aspiration biopsy sample showing chronic interstitial inflammation with fibrous thickening of alveolar septum with features of organizing pneumonia (A: H&E, ×200). Some alveolar spaces showing collection of many intra-alveolar foamy macrophages (B: H&E, ×400). A circle shows Oil Red O-positive lipid droplets in the alveolar macrophages.

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  Fig. 5 Electron micrographs showing the ultrastructures of foamy macrophages with numerous round to oval membrane-bound cytoplasmic inclusions (A, ×10,000). Higher magnification of inclusions showing characteristic, closely spaced concentrically arranged lamellae (B, ×20,000).

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