title: Successful treatment of severe amiodarone pulmonary toxicity with polymyxin B-immobilized fiber column direct hemoperfusion.
abstract: Amiodarone pulmonary toxicity (APT) is the most serious side effect of amiodarone. Although severe APT, such as ARDS, is rare, mortality of severe APT is high. Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is a medical device that reduces blood endotoxin levels in sepsis. Recent reports have shown that PMX-DHP improves oxygenation in patients with acute exacerbation of idiopathic pulmonary fibrosis and drug-induced severe interstitial pneumonia. Here, we present a case study of a patient with severe APT treated with PMX-DHP with complete recovery. The patient rapidly developed respiratory failure and required mechanical ventilation. Despite corticosteroid pulse therapy, no clinical improvement was noted. PMX-DHP was then started, and severe respiratory failure improved with reduction of serum levels of amiodarone and its metabolite monodesethylamiodarone. The patient was weaned from mechanical ventilation and has done well without recurrence. To our knowledge, this is the first reported case of PMX-DHP therapy for severe APT. We speculate that PMX-DHP could be a new treatment strategy for severe APT.
authors.affiliation: Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
authors.forename: Nahoko
authors.initials: N
authors.lastname: Sato
authors.affiliation: Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kojima
authors.affiliation: Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Horio
authors.affiliation: Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Goto
authors.affiliation: Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
authors.forename: Aiko
authors.initials: A
authors.lastname: Masunaga
authors.affiliation: Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ichiyasu
authors.affiliation: Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan. Electronic address: kohrogi@kumamoto-u.ac.jp.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kohrogi
mesh_terms: D000638:Amiodarone / Q000009:adverse effects* / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D011239:Prednisolone / Q000627:therapeutic use; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000628:therapy*; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D000889:Anti-Arrhythmia Agents; D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D011239:Prednisolone; D011112:Polymyxin B; D000638:Amiodarone