A case report and literature review: previously excluded tuberculosis masked by amiodarone induced lung injury

Autor: Jurgita Zaveckiene, Edmundas Kaduševičius, Vidas Pilvinis, Egle Karinauske, Silvijus Abramavicius, Greta Musteikiene, Edgaras Stankevičius
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
High-resolution computed tomography
medicine.medical_specialty
Tuberculosis
Giant Cell Arteritis
Adverse drug reaction
Amiodarone
Case Report
030204 cardiovascular system & hematology
Lung injury
Ventricular tachycardia
03 medical and health sciences
0302 clinical medicine
lcsh:RA1190-1270
Internal medicine
Humans
Medicine
Pharmacology (medical)
030212 general & internal medicine
Arteritis
Tuberculosis
Pulmonary
Aged
lcsh:Toxicology. Poisons
Pharmacology
medicine.diagnostic_test
business.industry
lcsh:RM1-950
Interstitial lung disease
Lung Injury
Amiodarone induced pulmonary toxicity
medicine.disease
Atrial fibrillation
respiratory tract diseases
Pneumonia
lcsh:Therapeutics. Pharmacology
Polypharmacy
Clinical pharmacology
Respiratory Insufficiency
Tomography
X-Ray Computed
business
Anti-Arrhythmia Agents
medicine.drug
Zdroj: BMC Pharmacology and Toxicology, Vol 19, Iss 1, Pp 1-6 (2018)
BMC Pharmacology & Toxicology
ISSN: 2050-6511
Popis: Background Amiodarone is an antiarrhythmic drug which is used to treat and prevent several dysrhythmias. This includes ventricular tachycardia and fibrillation, wide complex tachycardia, as well as atrial fibrillation (AF) and paroxysmal supraventricular tachycardia. Amiodarone may prove to be the agent of choice where the patient is hemodynamically unstable and unsuitable for direct current (DC) cardioversion. Although, it is not recommended for long-term use. The physician might encounter issues when differentiating amiodarone-induced lung toxicity with suspicion of interstitial lung disease, cancer or vasculitis. Adverse drug reactions are difficult to confirm and it leads to serious problems of pharmacotherapy. Case presentation A 78-year-old Caucasian male pensioner complaining of fever, dyspnea, malaise, non-productive cough, fatigue, weight loss, diagnosed with acute respiratory failure with a 16-year long history of amiodarone use and histologically confirmed temporal arteritis with long-term glucocorticosteroid (GCC) therapy. Patient was treated for temporal arteritis with GCC for ~ 1 year, then fever and dyspnea occurred, and the patient was hospitalized for treatment of bilateral pneumonia. Chest X-ray and chest high resolution computed tomography (HRCT) indicated several possible diagnoses: drug-induced interstitial lung disease, autoimmune interstitial lung disease, previously excluded pulmonary TB. Amiodarone was discontinued. Antibiotic therapy for bilateral pneumonia was started. Fiberoptic bronchoscopy with bronchial washings and brushings was performed. Acid fast bacilli (AFB) were found on Ziehl-Nielsen microscopy and tuberculosis (TB) was confirmed (later confirmed to be Mycobacterium tuberculosis in culture), initial treatment for TB was started. After a few months of treating for TB, patient was diagnosed with pneumonia and sepsis, empiric antibiotic therapy was prescribed. After reevaluation and M. Tuberculosis identification, the patient was referred to the Tuberculosis hospital for further treatment. After 6 months of TB treatment, pneumonia occurred which was complicated by sepsis. Despite the treatment, multiple organ dysfunction syndrome evolved and patient died. Probable cause of death: pneumonia and sepsis. Conclusions The current clinical case emphasizes issues that a physician may encounter in the differential diagnostics of amiodarone-induced lung toxicity with other lung diseases.
Databáze: OpenAIRE
Externí odkaz: