Amiodarone
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Acute pulmonary toxicity: case report A 61-year-old man developed acute pulmonary toxicity during treatment with amiodarone for atrial fibrillation. The man, who had a history of abdominal obesity, presented with a 3-week history of palpitations and dyspnoea. Upon evaluation, he was diagnosed with persistent atrial fibrillation. As an outpatient, he started receivingoral amiodarone 400mg (low impregnation dose) daily, along with carvedilol and warfarin. One month later, he presented with worsening of dyspnoea on minimal effort and persistent dry cough. No other symptomatology was reported. Physical examination showed globally decreased vesicular murmur and disseminated crepitus in lung fields, indicative of atrial fibrillation with a rapid ventricular response. Laboratory tests revealed mild leucocytosis. His ESR was 33 mm/second. As per the internal medicine department assessment, new onset of heart failure and community-acquired bacterial bronchopneumonia were suspected. Hence, the man’s treatment was started with cefuroxime and azithromycin, along with high-dose furosemide. His treatment with amiodarone and anticoagulation was continued. However, after 4 days of treatment, worsening of dyspnoea and cough was noted. Hence, he was admitted to the Coronary Care Unit. An echocardiogram revealed un-remodeled atria and acceptable biventricular systolic function. Therefore, on the same day, a computerised lung tomography scan was done, which showed opacities of inflammatory appearance with septal and bibasilar fibrous tracts thickening. The appearance of ground glass patterns indicated the possibility of interstitial lung disease. Therefore, a diagnosis of acute pulmonary toxicity caused by amiodarone was considered. Hence (on the fifth day after treatment initiation), treatment with antimicrobials, amiodarone and furosemide were stopped, and treatment with hydrocortisone was started. To control his ventricular rate, he also received digoxin and carvedilol. Ten days after the discontinuation of amiodarone and initiation of hydrocortisone, his respiratory profile and functional class significantly improved. His cough also reduced. His rheumatoid factor test was negative. Follow-up posteroanterior X-ray showed significant improvement in radio-opacities. The 64-slice follow-up single-scan tomography showed significant improvement. However, a persistent groundglass pattern with fine fibrous tracts to the periphery was observed. After 15 days of hospitalisation, spirometry revealed a mild restrictive pattern. Subsequently, he was discharged from the hospital with prednisone therapy for one month. Currently, he had functional class II. Cabrera-Rego JO, et al. Acute amiodarone pulmonary toxicity with low impregnation dose: case report. Medwave 20: No. 7, 14 Aug 2020. Available from: URL: http:// 803502916 doi.org/10.5867/medwave.2020.07.7996 [Spanish; summarised from a translation]
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Reactions 26 Sep 2020 No. 1823
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