Amiodarone-induced interstitial pneumonitis

Description

A man aged 62 years presented with shortness of breath (SOB) for 1 week. He has a history of non-ischaemic cardiomyopathy, diabetes mellitus and atrial fibrillation (AF). ECG revealed AF with rapid ventricular rate and chest X-ray was consistent with pulmonary congestion. He was treated with furosemide and electrically cardioverted for AF. The patient was started on amiodarone 400 mg once daily for maintenance of sinus rhythm. Eight months later, he presented with gradual onset SOB and dry cough. SOB did not improve with diuresis (13 L negative) empiric broad-spectrum antibiotics and mechanical ventilation. Blood cultures for bacteria did not reveal any growth. Urine antigen for legionella was negative, sputum cultures did not show any bacterial growth and PCR testing for Influenza A and B, H1N1, Adenovirus, Respiratory Syncitial Virus, Human Metapneumo Virus, Parainfluenza Virus were negative. The patient underwent flexible bronchoscopy and the mucosa of the visualised airway was...

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