HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Walter Weder Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lardinois, D. Articles by Weder, W. Search for Related Content PubMed Articles by Lardinois, D. Articles by Weder, W.

Ann Thorac Surg 2002;73:2033-2034
© 2002 The Society of Thoracic Surgeons

---

Correspondence

Acute amiodarone-induced pulmonary toxicity after lung operation

^a Division of Thoracic Surgery, University Hospital, Ramistrasse 100, 8091 Zurich, Switzerland

e-mail: didier.lardinois{at}chi.usz.ch

To the Editor

We read with interest the case report by Kaushik and associates [1] describing the rare but serious complication acute amiodarone-induced pulmonary toxicity after a short course of therapy for atrial fibrillation after a cardiac surgical procedure. We recently observed the same clinical presentation in a patient who underwent a middle lobe resection for non-small cell lung cancer stage IB. The onset of amiodarone-induced pulmonary toxicity was very early, after 3 days of therapy (cumulative dose of only 2,050 g), and initially mimicked a pneumonia. Adult respiratory distress syndrome developed within 2 weeks, and the patient had to be intubated. At that point, steroids were delivered intravenously at a daily dose of 2 x 100 mg, which allowed extubation after 6 days. The intravenous steroid therapy was continued for another week and then switched to oral administration for a total of 6 months. In the case of the patient described by Kaushik and colleagues, steroids were given orally at a dose of 3 x 40 mg from the eighth (date of onset of symptoms) to the 25th postoperative day. However, the condition of the patient worsened, and adult respiratory distress syndrome developed. Steroids were then given intravenously, but extubation was possible only 6 weeks later.

We support use of a liberal steroid therapy in patients in whom unexplained progressive respiratory insufficiency with bilateral parenchymal infiltrates develops after amiodarone administration, as the mortality rate among patients in whom adult respiratory distress syndrome develop is high [2]. Our experience suggests that early and prolonged use of a systemic steroid should be considered in the treatment of acute amiodarone-induced toxicity, as amiodarone pneumonitis can recur if steroids are discontinued early [3].

References

1. Kaushik S., Hussain A., Clarke P., Lazar H.L. Acute pulmonary toxicity after low-dose amiodarone therapy. Ann Thorac Surg 2001;72:1760-1761.[Abstract/Free Full Text]
2. Donaldson L., Grant I.S., Naysmith M.R., Thomas J.S.J. Acute amiodarone-induced lung toxicity. Intensive Care Med 1998;24:626-630.[Medline]
3. Ashrafian H., Davey P. Is amiodarone an underrecognized cause of acute respiratory failure in the ICU?. Chest 2001;120:275-282.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Walter Weder Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lardinois, D. Articles by Weder, W. Search for Related Content PubMed Articles by Lardinois, D. Articles by Weder, W.