Acute amiodarone pulmonary toxicity in the form of organizing pneumonia triggered by orthotopic heart transplantation
| Autor: | Gregg M. Lanier, Oleg Epelbaum, Natalya Kozlova, George Kleinman |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Heart transplantation Mechanical ventilation medicine.diagnostic_test RC705-779 Pulmonary toxicity business.industry medicine.medical_treatment Amiodarone Case Report Ventricular tachycardia medicine.disease Regimen Diseases of the respiratory system Bronchoscopy Anesthesia medicine Chest radiograph business medicine.drug Organizing pneumonia |
| Zdroj: | Respiratory Medicine Case Reports Respiratory Medicine Case Reports, Vol 34, Iss, Pp 101532-(2021) |
| ISSN: | 2213-0071 |
| Popis: | We report a case of a 60-year-old man who underwent orthotopic heart transplantation after short-term receipt of low-dose oral amiodarone for the management of ventricular tachycardia. Prior to transplant surgery, he had a normal chest radiograph and was free of supplemental oxygen. His initial postoperative chest radiograph showed subtle infiltrates, and thereafter his chest imaging continued to worsen. Although he was eventually able to wean off mechanical ventilation via a tracheostomy, he remained dyspneic and oxygen-dependent with persistently abnormal chest imaging as his post-transplant corticosteroid regimen was being tapered. In light of progressively worsening diffuse lung disease, he underwent bronchoscopy with transbronchial biopsies. Histology revealed foamy macrophages in association with foci of organizing pneumonia, a picture consistent with amiodarone pulmonary toxicity. Given these findings, corticosteroid dosing was increased for the clinical diagnosis of acute amiodarone pulmonary toxicity with subsequent normalization of oxygen saturation and chest radiography. Our case is the first to identify orthotopic heart transplantation as a potential trigger for acute amiodarone pulmonary toxicity. It is also only the second documented example of organizing pneumonia as the histological substrate of amiodarone pulmonary toxicity, which is an association that has therapeutic implications. Highlights • Amiodarone pulmonary toxicity can present acutely, often precipitated by cardiothoracic interventions. • Organizing pneumonia has only rarely been shown to underlie acute amiodarone pulmonary toxicity. • Orthotopic heart transplantation surgery was the putative trigger in the present case, making this the first such description. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|