INTERSTITIAL PNEUMOPATHY INDUCED BY AMIODARONONE, A DIAGNOSIS THAT MUST BE REMEMBERED (Atena Editora)

Abstract

Organizing pneumonia secondary to the use of amiodarone is rare, with an interstitial pattern mostly of subacute or chronic clinical onset, with less than 10 cases described in the literature. The initial clinical suspicion is usually suggested as a respiratory tract infection, with persistent cough and progressive dyspnea. Usually, the disease is idiopathic, however, it can be associated with connective tissue diseases, radiation, drug toxicity (in addition to amiodarone, gold, cocaine and crack) and infections. In the complementary exams, moderate hypoxemia, radiography with interstitial-alveolar infiltrate, mainly in the lung bases, pulmonary function test with restrictive ventilatory disorder and decreased diffusion are found. Amiodarone is a drug widely used for the treatment of cardiac arrhythmias, and its mechanism of drug toxicity is not well known, but there are indications that it is dose-dependent, with an increased risk being well reported in doses above 400mg/day, or even low doses (100 mg/day) for prolonged periods. Its half-life is long, from 40 to 70 days, which means that improvement will be seen after discontinuation within months. Most with a good prognosis, all treated with corticosteroids have marked improvement after two to six weeks, and recurrences are rare. In the present report, an 86-year-old female patient, with cumulative use of this medication, had a chest tomography showing areas of mosaic paving with parenchymal retraction. After discontinuing the medication, the clinical picture was stabilized and the lung parenchyma recovered, in addition, she was treated with systemic corticosteroids – prednisone and inhaled – budesonide due to her pulmonary comorbidity, COPD.