Amiodarone Pulmonary Toxicity

Abstract

Pulmonary toxicity may occur in association with amiodarone hydrochloride therapy. The clinical features of the pulmonary involvement are mild dyspnea, leukocytosis, hypoxemia, elevation in the erythrocyte sedimentation rate, and restrictive changes on pulmonary function testing. Diffuse interstitial and patchy peripheral alveolar infiltrates, which may frequently involve the upper lobes, characterize the radiologic findings. Accumulation of foamy macrophages in alveolar spaces, hyperplasia of type II pneumocytes, and widening of alveolar septae are noted histologically. Ultrastructural examination shows granular and lamellar membranous structures within distended lysosomes. With cessation of amiodarone therapy and treatment with corticosteroids, clinical symptoms and radiographic abnormalities resolve. The time interval for resolution of radiographic changes appears to be greater than 2 months. The precise role of corticosteroid therapy remains unknown in light of pathologic findings suggesting a metabolic rather than immunologic basis for the toxicity.

ALVEOLAR PROTEINOSIS (A Case Report)

“…In some cases various predisposing factors like consanguinity in marriage, pulmonary alveolar proteinosis in siblings, previous infective processes like tuberculosis, fungal diseases. HIV infection, connective tissue diseases and even use of some drugs are present and this group is called secondary [2,4,5,7].…”

“…Histologically the material appears granular and eosinophilic and is strongly positive to periodic-acidSchiff (PAS) stain. This is a relatively new disease which was first reported by Rosen ei al in 1 D5B [:1] and by 1DBO only 260 cases were reported in world literature [2]. An open lung biopsy was performed which revealed areas of alveolar exudates, which were granular.…”

“…P u lm onary alveolar protoinosis (PAP) or pulmonary alveolar lipoproteinosis is a rare entity of unknown etiology caused by deposition of lipid-rich proteinaceous matorial in the alveoli [1,2). Histologically the material appears granular and eosinophilic and is strongly positive to periodic-acidSchiff (PAS) stain.…”

Serious adverse effects of amiodarones

“…Two of these six patients died. Marchlinski et al (1982) found a 6% incidence of pulmonary changes in their patients. Preliminary data from Greene et al (1982) are of particular concern.…”

“…Sequential changes in pulmonary function tests in patients with severe cardiac disease treated with other antianhythmic drugs have not been reported, thus the role of amiodarone in producing these changes is as yet unknown. Marchlinski et al (1982) described the clinical, radiological, and pulmonary function findings in four patients. All patients had mild dyspnea, leukocytosis, hypoxemia, elevation in the erythrocyte sedimentation rate, and restrictive changes on pulmonary function testing.…”