Amiodarone-induced Alveolar Hemorrhage

Abstract

Amiodarone is increasingly prescribed for patients with ventricular and supraventricular tachyarrhythmias. Many adverse effects have been reported due to this drug and include injury to the liver, thyroid, cornea, skin, and neuromuscular system. Pulmonary toxicity is one of the more serious side effects of this anti-arrhythmic drug and is potentially fatal. Since the first case of amiodarone-induced pneumonitis was described in the early 1980s, amiodarone pneumonitis has been recognized as a distinctive and not uncommon form of drug-induced lung injury. On the other hand, amiodarone-induced pulmonary toxicity resulting in alveolar hemorrhage is rare. The authors report a patient with amiodarone-induced alveolar hemorrhage and review the literature.

Amiodarone-induced Alveolar Haemorrhage: A Rare Complication of a Common Medication

“…Most patients with amiodarone-induced alveolar haemorrhage had an acute onset of cough, shortness of breath, and fever. Interestingly, haemoptysis, an important clue leading to bronchoscopy in our patient, was found in only 2 cases [4,[8][9][10][11]. In our patient, the findings from bronchoscopy and sequential bronchoalveolar lavage along with the presence of numerous haemosiderin-laden macrophages in histopathology study confirmed the diagnosis of diffuse alveolar haemorrhage.…”

“…APT is a diagnosis of exclusion and the clinical presentation of APT is variable [3], making the diagnosis difficult. Diffuse alveolar haemorrhage, one of the life-threatening entities of APT, is rarely reported [4] and appears to be underrecognised [5]. We therefore describe a patient with new onset atrial fibrillation and ventricular arrhythmia that developed diffuse alveolar haemorrhage within a short period after the initiation of amiodarone.…”

Nodular Amiodarone Lung Disease

“…Less common findings include bronchiolitis obliterans organizing pneumonia, 25,33 pulmonary hemorrhage, 9,31 diffuse alveolar damage, 7,16,34 and nodular inflammation. 2,3,5,8,10,14,22,23,[27][28][29] An important finding is vacuolization of cytoplasm in pneumocytes and endothelial cells as well as histiocytes with ultrastructurally characteristic intracytoplasmic lamellar inclusion bodies.…”

Interstitial Lung Disease Associated With Taking of Amiodarone

“…развивается у 0,1% больных, получавших невысокие дозы препаратов в течение длительного времени и от 5 до 15% у пациентов, принимающих более 500 мг в сутки данного препарата [1,2,7,10]. При этом считается, что низкие дозы амиодарона являются безопасными, но развитие «амиода-ронового легкого» по данным литературы наблюдается и у людей, принимающих его в течение двух лет по 1 таблетке (200 мг) в день [7].…”

“…Установленный в кратчайшие сроки от развития клинической симптоматики диагноз и назначенное более раннее лечение, как правило, приводят к благоприят-ному прогнозу [15]. Смертность от токсического действия амиодарона на легочную ткань у пациентов, принимающих более 400 мг в сутки, составляет от 5 до 10% [7], а при развитии острого респираторного дистресс-синдрома, требующего искусственной вентиляции легких, смертность достигает от 50 до 100% [5,10]. Причиной побочного действия препарата является как неосведомленность врачей и пациентов, полу-чающих препарат [3], так и незнание фармакокинетики.…”