The Dangers Of Judicious Amiodarone Use: An Unusual Case Of Amiodarone Toxicity | 54966
Journal of Pulmonary & Respiratory Medicine
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Amiodarone is highly efficacious as a medical therapy for cardiac arrhythmias. Amiodarone pulmonary toxicity, which can
be presented as eosinophilic pneumonia, organizing pneumonia, acute respiratory distress syndrome (ARDS), diffuse
alveolar hemorrhage, or pulmonary nodules and masses, is one of many severe potential side effects of this medication. The
mechanisms involved in amiodarone-induced lung injury remain unclear, but may include direct toxic effect or an indirect
immunologic reaction. This case involves a patient who developed amiodarone toxicity requiring intubation secondary to
ARDS after a short course on a low dose of the medication. In this study a 79-year-old female who was presented to the
emergency department with a two-day history of productive cough, pleurisy, worsening fatigue, and shortness of breath was
considered. She had been on amiodarone for the previous six weeks for treatment of atrial flutter/fibrillation. Chest computed
tomography showed diffused patchy foci of ground glass opacification in both lungs, likely secondary to a drug reaction from
amiodarone toxicity. Patient had increased oxygen requirements throughout her hospitalization despite treatment with high
dose steroids, diuresis and empiric antibiotic coverage. She required non-invasive ventilation with increasing frequency, later
requiring intubation, and eventual withdrawal from life-sustaining measures. Amiodarone toxicity is a diagnosis of exclusion
and remains perplexing from both a management and prognostic perspective. There are documented effects on the thyroid,
heart, liver, skin, bone marrow, eyes, and lungs. While toxicity is rare, the potential complications can be lethal. Therefore, this
medication should be used with caution due to its potential unpredictable side effect profile.
Kathryn Tapper has completed her Medical degree from the George Washington University School of Medicine and Health Sciences in Washington. She is currently pursuing her final year of Residency in Family Medicine at the Mayo Clinic in Jacksonville, Florida. She is currently serving as one of the Chief Residents of the Family Medicine Residency Program at Mayo Clinic.