Amiodarone-Other Pulmonary Manifestations

Introduction. Cryptogenic organizing pneumonia (COP), first described in 1985 as BOOP bronchiolitis obliterans organizing pneumonia, is an acute inflammatory disease characterized histopathologically by intracellular granulomas formed by connective tissue and miofibroblasts (Masson bodies).

Case presentation. 62-year-old female patient, known with type 2 DZ, ICC, CIND (paroxysmal FiA) and HTAE, under treatment with Amiodarone, is hospitalized with acute respiratory symptomatology. Laboratory tests show bilateral basaltic crepitation risers, biological inflammatory syndrome, and radiologically multiple opacities with ½ inferior condensation appearance for which empiric antibiotic treatment was initiated. Evolution of the patient was unfavourable, despite antibiotic treatment. Therefore, it is decided to do a fibrobronchoscopic examination (bronchial aspiration for cytology and BK), thoracic CT followed by thoracoscopy and pulmonary biopsy.

The diagnosis of COP was based on the typical radiological appearance of bronchopneumonia but that is not responding to antibiotic treatment. The bronchoalveolar lavage revealed nonspecific inflammatory infiltration with lymphocytes and polymorphonuclear cells, the histopathological examination revealed the presence of Masson bodies, alveolar fibroblast polyps and bronchiolar polyps. As amiodarone is known to have pulmonary adverse effects, among which COP was very rarely quoted, treatment with amiodarone was discontinued and cortisone treatment with prednisone 70 mg/day was initiated, with rapid progressive improvement of symptomatology and slow improvement of imaging. In treatment month 3, after the decrease in prednisone to 30 mg/day, the general condition of the patient worsens in parallel with the biological and imaging parameters secondary to the reintroduction of the amiodarone treatment, an event treated as a recurrence of drug-induced obliterans pneumonia. The evolution of the patient was favourable, with the remission of clinical symptoms and radiological appearance, in the absence of relapses one and a half years after the end of the treatment.

Conclusions. This paper presents a complete case of cryptogenic organizing pneumonia in a patient undergoing amiodarone treatment, which has a complete response to cortisone treatment only after the trigger factor has been removed.