title: Procainamide-induced pulmonary fibrosis after orthotopic heart transplantation: a case report and literature review.
abstract: A 33-year-old African-American woman was bridged to heart transplantation with a left ventricular assist device. She had a 14-month history of heart failure secondary to viral cardiomyopathy. The patient's refractory ventricular tachycardia was treated with intravenous procainamide owing to the patient's history of amiodarone-induced thyroiditis. After orthotopic cardiac transplant, she experienced prolonged respiratory failure. Serial computed tomography evaluation of the lung revealed diffuse bilateral ground-glass opacities and septal thickening. Bronchoscopies with tissue biopsies were performed with no conclusive results. Specimen samples displayed septal fibrosis with loose fibromyxoid tissue and some hobnail nodularities with no indication of granulomas, neutrophilic infiltration, malignancy, or fungal, viral, or bacterial growth. Histopathological evaluation of the lung wedge biopsy supported a diagnosis of pulmonary fibrosis and noted interstitial fibrosis with areas of focal alveolar hemorrhage and increased macrophage infiltration. Antinuclear body was found to be negative. After in-depth evaluation of the patient's medication history, procainamide was identified as the cause of the toxicity. As procainamide-induced lung fibrosis is relatively uncommon, we present this case to highlight procainamide's potential harm and the need for careful monitoring in postsurgical patients.
authors.affiliation: Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin Street, Suite 2350, Houston, TX 77030, USA.
authors.forename: Manoj
authors.initials: M
authors.lastname: Thangam
authors.affiliation: Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin Street, Suite 2350, Houston, TX 77030, USA.
authors.forename: Sriram
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin Street, Suite 2350, Houston, TX 77030, USA.
authors.forename: Marija
authors.initials: M
authors.lastname: Petrovica
authors.affiliation: Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin Street, Suite 2350, Houston, TX 77030, USA.
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
authors.affiliation: Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin Street, Suite 2350, Houston, TX 77030, USA.
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.affiliation: Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin Street, Suite 2350, Houston, TX 77030, USA.
authors.forename: Pranav
authors.initials: P
authors.lastname: Loyalka
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin Street, Suite 2350, Houston, TX 77030, USA.
authors.forename: L Maximilian
authors.initials: LM
authors.lastname: Buja
authors.affiliation: Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin Street, Suite 2350, Houston, TX 77030, USA. Electronic address: Francine.Cummings@uth.tmc.edu.
authors.forename: Igor D
authors.initials: ID
authors.lastname: Gregoric
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D001999:Bronchoscopy; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007150:Immunohistochemistry; D008168:Lung / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D011342:Procainamide / Q000009:adverse effects*; D011658:Pulmonary Fibrosis / Q000139:chemically induced* / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D011342:Procainamide
keywords: Heart transplantation; Procainamide; Pulmonary fibrosis