Acute amiodarone pulmonary toxicity in the form of organizing pneumonia triggered by orthotopic heart transplantation. (2021)

• Record Type: Journal Article
• Authors: Kozlova, Natalya; Lanier, Gregg M.; Kleinman, George; Epelbaum, Oleg
• Is Part Of: Respiratory medicine case reports. Volume 34(2021)
• Publication Date: 2021
• Subjects: Amiodarone -- Pulmonary toxicity -- Organizing pneumonia -- Heart transplantation; Respiratory organs -- Diseases -- Periodicals; Chest -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Respiratory System -- Periodicals; Chest -- Diseases; Respiratory organs -- Diseases; Electronic journals; Periodicals; 616.2
• DOI: 10.1016/j.rmcr.2021.101532
• Languages: English
• ISSNs: 2213-0071

Abstract

Abstract: 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.