Figure 17.

Chest X-ray (A and B), computed tomography (CT) scan (C), and microscopic views of a lung biopsy (D and E) from a 77-year-old former smoker with a history of old myocardial infarction and preserved left ventricular ejection fraction, taking 200 mg/day of amiodarone for paroxysmal atrial fibrillation. The patient presented with cough, dyspnoea, and weight loss. Findings were suggestive of amiodarone-induced lung toxicity. (A) Chest X-ray at presentation showing a diffuse alveolar-interstitial pattern indicative of pulmonary involvement. (B) Follow-up chest X-ray after 3 months of amiodarone withdrawal and steroid therapy showing resolution of lung abnormalities. (C) Computed tomography scan confirming the diffuse alveolar-interstitial pattern at the initial presentation. (D) Optical microscopy (haematoxylin–eosin stain) of lung parenchyma showing clusters of alveolar macrophages (arrows) with foam-like cytoplasmic changes, characteristic of amiodarone toxicity. (E) Electron microscopy of the biopsy sample revealing phospholipid inclusions (red arrow) in macrophages, further confirming the diagnosis of amiodarone-induced pulmonary toxicity. This case underscores the potential for severe pulmonary adverse effects associated with amiodarone therapy and the potential reversibility of findings following drug discontinuation and appropriate treatment.