Amiodarone induced pneumonitis and hyperthyroidism: case report.
Amiodarone is a highly effective antiarrhythmic agent used in life-threatening ventricular and supraventricular arrhythmias. Its long-term use may however lead to several adverse effects, including corneal deposits, liver and thyroid gland dysfunction, lung lesions, bone marrow injury, skin lesions, or neurological abnormalities. The article presents the case of a 56-year-old man with a history of a stroke, who after a few days of amiodarone therapy for an episode of atrial fibrillation was diagnosed with amiodarone-induced hyperthyroidism and interstitial pulmonary lesions. Clinical and laboratory symptoms of hyperthyroidism and radiographic signs of pulmonary involvement did not occur until several weeks after discontinuation of amiodarone therapy. Differential diagnosis of causes of hyperthyroidism and diseases causing nodular pulmonary lesions did not demonstrate any other pathologies. Empirical antibiotic therapy and administration of thiamazole and high doses of propranolol failed to improve the patient's clinical status. It was not until thiamazole was given in combination with glucocorticosteroids, when a slow relief of hyperthyroidism symptoms and resolution of radiographic pulmonary signs were observed. Based on the presented case, the risk of appearance of 2 serious concomitant adverse effects was demonstrated, even following a short-term amiodarone therapy. This paper also contains an overview of adverse effects which may be encountered during or after therapy with this effective antiarrhythmic agent. It was emphasized how important it is to select patients appropriately, and to monitor potential adverse effects during amiodarone therapy.
Chair and Department of internal Diseases, Pneumonology and Allergology, Warsaw Medical University, Warszawa, Poland. mgrabczak@yahoo.com
Elzbieta Magdalena
EM
Grabczak
Tadeusz M
TM
Zielonka
Joanna
J
Wiwała
Anna Dagmara
AD
Bareła
Andrzej
A
Opuchlik
Anna
A
Potulska
Urszula
U
Ambroziak
Ryszarda
R
Chazan
D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000209:etiology / Q000628:therapy*; D003937:Diagnosis, Differential; D006801:Humans; D006980:Hyperthyroidism / Q000139:chemically induced* / Q000175:diagnosis; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000187:drug effects; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone