Amiodarone-Induced Pulmonary Toxicity

Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.

Click here for the case description and questions.

What happened next?

Amiodarone-induced pulmonary toxicity was suspected.

The patient was diagnosed with AFib with RVR (difficult to control) one year ago. He was started on Amiodarone 400 mg qd, then the dose was decreased to 200 mg qd.

What are the tests of choice for Amiodarone-induced pulmonary toxicity?

High-resolution CT scan of the chest and PFT with DLCO.


High-resolution CT of the chest (click to enlarge the images).


High-resolution CT of the chest (click to enlarge the images).


High-resolution CT of the chest (click to enlarge the images).

Report of the CT of the chest: Nonspecific diffuse ground glass mosaic pattern of the lung parenchyma. There are bilateral linear scars or atelectases particularly into the lower lobes and right middle lobe. Impression: Nonspecific ground glass mosaic pattern indicating interstitial lung disease.

Final diagnosis

Amiodarone-induced pulmonary toxicity.

What did we learn from this case?

Amiodarone-induced lung toxicity occurs in 6-15% of the patients treated with the medication. A decrease of 15% in DLCO helps make the diagnosis.

Toxicity occurs even with the lower amiodarone doses such as 200 mg qd.

The treatment is with a corticosteroid trial, similar to the therapy of other idiopathic interstitial lung diseases. However, there is no conclusive evidence that that steroids are beneficial in the treatment of amiodarone-induced lung toxicity.

References

Pneumonitis and pulmonary fibrosis associated with amiodarone treatment: a possible complication of a new antiarrhythmic drug. This is the first report of Amiodarone-induced pulmonary toxicity, Circulation, 1982.
Amiodarone - Reevaluation of an Old Drug. Annals of Int Med.
Amiodarone-Induced Pulmonary Toxicity. NEJM Images.
Pulmonary Fibrosis, Idiopathic. eMedicine.
Amiodarone pulmonary toxicity. VH.org.
Amiodarone: Guidelines for Use and Monitoring. AFP 12/03.

Published: 05/20/2009
Updated: 05/20/2009

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