The importance of amiodarone pulmonary toxicity in the differential diagnosis of a patient with dyspnea awaiting a heart transplant.

Amiodarone is a class III antiarrhythmic medication used extensively to treat ventricular arrhythmias. It is pharmacologically classified as a cationic amphiphilic drug due to its polar and apolar components. During the past few years, amiodarone has proved to be an effective treatment therapy for patients with ventricular dysfunctions, regardless of the etiology, and in particular ventricular arrhythmia associated with Chagas disease. Nevertheless, despite its hemodynamic and electrophysiological benefits, amiodarone produces serious collateral effects such as a bluish skin discoloration, photosensitivity, thyroid dysfunction, corneal deposit, peripheral neuropathy, bone marrow suppression, hepatitis, heart blocks, pneumonitis, among others. The objective of this case report is to discuss one of the most serious complications related to amiodarone, pulmonary toxicity, which is described as a differential diagnosis for a chagasic patient that was on the waiting list for a heart transplant. Amiodarone pneumonitis is a relevant differential diagnosis for heart failure (HF) patients using amiodarone that are admitted to the emergency ward with dyspnea.

[1]  K. Miyasaka,et al.  Detection of amiodarone-induced pulmonary toxicity in supine and prone positions: high-resolution computed tomography study. , 2005, Circulation journal : official journal of the Japanese Circulation Society.

[2]  T. Paterick,et al.  Pulmonary toxicity in patients receiving low-dose amiodarone. , 2003, Chest.

[3]  T. Massey,et al.  Attenuation of Amiodarone-Induced Pulmonary Fibrosis by Vitamin E Is Associated with Suppression of Transforming Growth Factor-β1 Gene Expression but Not Prevention of Mitochondrial Dysfunction , 2003, Journal of Pharmacology and Experimental Therapeutics.

[4]  Z. Burak,et al.  Technetium-99m-DTPA aerosol scintigraphy in amiodarone induced pulmonary toxicity in comparison with Ga-67 scintigraphy , 2002, Annals of nuclear medicine.

[5]  J. Oss,et al.  PROPHYLACTIC IMPLANTATION OF A DEFIBRILLATOR IN PATIENTS WITH MYOCARDIAL INFARCTION AND REDUCED EJECTION FRACTION , 2002 .

[6]  M. Mehra,et al.  Amiodarone Lung Injury: Another Heart Failure Mimic? , 2002 .

[7]  E. Oechslin,et al.  Amiodarone-induced pulmonary mass and cutaneous vasculitis , 2001, The Lancet.

[8]  J. L. Rodríguez-García,et al.  Pulmonary mass and multiple lung nodules mimicking a lung neoplasm as amiodarone-induced pulmonary toxicity. , 2001, European journal of internal medicine.

[9]  H. Ashrafian,et al.  Is amiodarone an underrecognized cause of acute respiratory failure in the ICU? , 2001, Chest.

[10]  Karl-HeinzKuck,et al.  Randomized Comparison of Antiarrhythmic Drug Therapy With Implantable Defibrillators in Patients Resuscitated From Cardiac Arrest , 2000 .

[11]  R. Cappato,et al.  Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH). , 2000, Circulation.

[12]  K. Lee,et al.  A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. , 1999, The New England journal of medicine.

[13]  P. Pollak,et al.  Clinical organ toxicity of antiarrhythmic compounds: ocular and pulmonary manifestations. , 1999, The American journal of cardiology.

[14]  J. Ohar,et al.  Amiodarone pulmonary toxicity: cytopathology, ultrastructure, and immunocytochemistry. , 1997, Annals of diagnostic pathology.

[15]  B. Murer,et al.  Bronchiolitis obliterans organizing pneumonia secondary to amiodarone: clinical, radiological and histological pattern. , 1997, Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace.

[16]  A. Moss,et al.  Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. , 1996, The New England journal of medicine.

[17]  L. E. Alves,et al.  Amiodarone and the development of ARDS after lung surgery. , 1994, Chest.

[18]  E. Retyk,et al.  Ventricular tachycardia in Chagas' disease. , 1992, The American journal of cardiology.

[19]  E C Rosenow,et al.  Amiodarone Pulmonary Toxicity: Recognition and Pathogenesis (Part 2) , 1988 .

[20]  M. Lesch,et al.  Amiodarone-induced pneumonitis. Assessment of risk factors and possible risk reduction. , 1988, Chest.

[21]  J. I. Kennedy,et al.  Amiodarone lung: pathologic findings in clinically toxic patients. , 1987, Human pathology.

[22]  M. Josephson,et al.  Amiodarone pulmonary toxicity. , 1982, Annals of internal medicine.

[23]  H. Rotmensch,et al.  Possible association of pneumonitis with amiodarone therapy. , 1980, American heart journal.

[24]  M. Mehra,et al.  Difficult cases in heart failure: amiodarone lung injury: another heart failure mimic? , 2002, Congestive heart failure.

[25]  E. Oechslin,et al.  Clinical picture: Amiodarone-induced pulmonary mass and cutaneous vasculitis. , 2001, Lancet.

[26]  N Engl,et al.  Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. , 1997, Circulation.

[27]  G. Deneffe,et al.  Amiodarone and the development of ARDS after lung surgery. , 1994, Chest.

[28]  E C Rosenow,et al.  Amiodarone pulmonary toxicity. Recognition and pathogenesis (Part I). , 1988, Chest.