title: An unintended consequence: fatal amiodarone pulmonary toxicity in an older woman.
abstract: Amiodarone pulmonary toxicity represents the most serious adverse reaction from amiodarone use. It remains underdiagnosed and can have a variable presentation. The elderly population is at increased risk for amiodarone pulmonary toxicity. Thus, clinicians should prescribe the lowest dosage possible in the elderly and have a low threshold to discontinue the amiodarone for anyone with unexplained fatigue, dyspnea, cough, or weight loss. We present the case of an 89-year-old female who presented with a several month history of fatigue and recent development of dyspnea on exertion and a dry cough. She had been taking amiodarone for 1 year secondary to atrial fibrillation. Chest x-ray and chest CT revealed multilobar airway opacities. An infectious work-up was negative and a transbronchial biopsy revealed prominent intra-alveolar foamy macrophages, consistent with amiodarone pulmonary toxicity. Despite the prompt discontinuation of her amiodarone and a trial of intravenous steroids, the patient succumbed to respiratory failure. The risk factors, clinical presentation, diagnosis, treatment, and prevention of amiodarone pulmonary toxicity are discussed.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA CA 90095-1690, USA. tiwang@mednet.ucla.edu <tiwang@mednet.ucla.edu>
authors.forename: Tisha
authors.initials: T
authors.lastname: Wang
authors.forename: Susan
authors.initials: S
authors.lastname: Charette
authors.forename: M Iain
authors.initials: MI
authors.lastname: Smith
mesh_terms: D000369:Aged, 80 and over; D000638:Amiodarone / Q000008:administration & dosage / Q000506:poisoning*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000506:poisoning*; D005260:Female; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008171:Lung Diseases / Q000175:diagnosis / Q000401:mortality* / Q000532:radiotherapy; D012307:Risk Factors
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone