Complex and Severe Amiodarone-Induced Pleuro- Pulmonary Toxicity

Abstract

IntroductionAmiodarone is a class III antiarrhythmic agent widely used for the treatment of ventricular and supraventricular rhythm disorders [1,2]; its spectrum of toxicity is wide: thyroid, heart, lung, eye, skin, liver, gastrointestinal tract, and central nervous system [3]. All these effects are mediated by the mitochondrial toxicity of the drug and its lipophilicity. This toxicity is not dose-dependent, can occur even very early, and men seems to be more exposed than women [4]. The current incidence of amiodarone pneumonia is estimated at 1.6-2% [5,6]. His most classic presentation is acute or subacute pneumonia, while pleural involvement is exceptional [3,7] and often described as an unusual manifestation of amiodarone-induced pneumopathy [7,8]; similarly, acute hepatitis under amiodarone is very rare (<3%) [6]. We are reporting an original observation of triple toxicity to amiodarone with concomitant bilateral pleural, pulmonary parenchymal and hepatic involvement.