Abstract
Amiodarone, which has been used since 1967 as an antiarrhythmic drug, gives rise to a variety of cardiac and extracardiac adverse side-effects. Among these, pulmonary toxicity is considered the most frequent and serious extracardiac side-effect, since it may occur in various atypical forms and often limits the drug’s clinical use. We encountered a 67-year-old white male patient with suspected amiodarone pneumonitis characterized by multiple lung nodules associated with pleural and pericardial effusion and peripheral neuropathy. Because differential diagnosis with pulmonary infectious diseases may be extremely difficult, the attending physician should therefore bear in mind the possibility of amiodarone pneumonitis whenever the drug is given.
Key words: Amiodarone, arrhythmia, neuropathy, pneumonitis, steroids
References
- 1.Ruangchira-Urai R, Colby TV, Klein J, et al. Nodular amiodarone lung disease. Am J Surg Pathol. 2008;32:1654–60. doi: 10.1097/PAS.0b013e31816d1cbc. [DOI] [PubMed] [Google Scholar]
- 2.Rotmensch HH, Liron M, Tupilski M, et al. Possible association of pneumonitis with amiodarone therapy. Am Heart J. 1980;100:412–3. doi: 10.1016/0002-8703(80)90165-9. [DOI] [PubMed] [Google Scholar]
- 3.Piccini JP, Berger JS, O’Connor CM. Amiodarone for the prevention of sudden cardiac death: a meta-analysis of randomized controlled trials. Eur Heart J. 2009;30:1245–53. doi: 10.1093/eurheartj/ehp100. [DOI] [PubMed] [Google Scholar]
- 4.Siddoway LA. Amiodarone: guidelines for use and monitoring. Am Fam Physician. 2003;68:2189–96. [PubMed] [Google Scholar]
- 5.Dusman RE, Stanton MS, Miles WM, et al. Clinical features of amiodarone-induced pulmonary toxicity. Circulation. 1990;82:51–9. doi: 10.1161/01.CIR.82.1.51. [DOI] [PubMed] [Google Scholar]
- 6.Martin W I, Rosenow E III. Amiodarone pulmonary toxicity. Recognition and pathogenesis (Part I) Chest. 1988;93:1067–75. doi: 10.1378/chest.93.5.1067. [DOI] [PubMed] [Google Scholar]
- 7.Donaldson L, Grant IS, Naysmith MR, et al. Acute amiodarone-induced lung toxicity. Intensive Care Med. 1998;24:626–30. doi: 10.1007/s001340050627. [DOI] [PubMed] [Google Scholar]
- 8.Pollak PT. Clinical organ toxicity of antiarrhythmic compounds: ocular and pulmonary manifestations. Am J Cardiol. 1999;84:37R–45R. doi: 10.1016/S0002-9149(99)00700-6. [DOI] [PubMed] [Google Scholar]
- 9.Morissette G, Ammoury A, Rusu D, et al. Intracellular sequestration of amiodarone: role of vacuolar ATPase and macroautophagic transition of the resulting vacuolar cytopathology. Br J Pharmacol. 2009;157:1531–40. doi: 10.1111/j.1476-5381.2009.00320.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Stadler K, Ha HR, Ciminale V, et al. Amiodarone alters late endosomes and inhibits SARS coronavirus infection at a post-endosomal level. Am J Respir Cell Mol Biol. 2008;39:142–9. doi: 10.1165/rcmb.2007-0217OC. [DOI] [PubMed] [Google Scholar]
- 11.Camus P, Martin W I, Rosenow E III. Amiodarone pulmonary toxicity. Clin Chest Med. 2004;25:65–75. doi: 10.1016/S0272-5231(03)00144-8. [DOI] [PubMed] [Google Scholar]
- 12.Chang SN, Hwang JJ, Hsu KL, et al. Amiodarone-related pneumonitis. J Formos Med Assoc. 2007;106:411–7. doi: 10.1016/S0929-6646(09)60328-4. [DOI] [PubMed] [Google Scholar]
- 13.Orr CF, Ahlskog JE. Frequency, characteristics, and risk factors for amiodarone neurotoxicity. Arch Neurol. 2009;66:865–9. doi: 10.1001/archneurol.2009.96. [DOI] [PubMed] [Google Scholar]
- 14.Stewart JI, Chawla R, Lloyd JM, et al. Amiodarone pneumonitis. Resp Care. 2008;53:370–5. [PubMed] [Google Scholar]
- 15.Van Rooij WJ, van der Meer SC, van Royen EA, et al. Pulmonary gallium-67 uptake in amiodarone pneumonitis. J Nucl Med. 1984;25:211–3. [PubMed] [Google Scholar]