Chest
Volume 102, Issue 4, October 1992, Pages 1005-1012
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Amiodarone Pneumonitis: Bronchoalveolar Lavage Findings in 15 Patients and Review of the Literature

https://doi.org/10.1378/chest.102.4.1005Get rights and content

Amiodarone (Am) pneumonitis is currently a common and potentially severe adverse reaction, the accurate diagnosis of which remains difficult to establish.

Objectives: To determine the contribution of bronchoalveolar lavage (BAL) in the diagnostic workup of patients suspected of having Am pneumonitis.

Methods: Diagnosis of Am pneumonitis was established on the basis of (1) development of recent symptoms and pulmonary opacities while receiving the drug, (2) exclusion of other possible causes, and (3) improvement following cessation of Am and/or steroid therapy. (4) Confirmatory changes were obtained by histopathologic examination in eight cases. BAL was performed in each patient at the time of initial evaluation.

Results: Am pneumonitis was diagnosed in 15 consecutive patients between 1985 and 1991. The disease was associated with significant morbidity and mortality. Six patients died; four died of Am pneumonitis. A neutrophilic BAL was found in nine patients (average PMN = 26.6 percent). A mixed pattern (lymphocytic + neutrophilic) was seen in four patients (average: Ly = 19.9 percent; PMN = 11.9 percent). Two patients had a normal BAL. No patient had a lymphocytic pattern. A low CD4+/CD8+ ratio was seen in two patients. A literature survey indicated 70 cases of Am pneumonitis with detailed information on BAL. The BAL pattern was mixed in 23 (33 percent), neutrophilic in 18 (26 percent), lymphocytic in 15 (21 percent), and normal in 14 (20 percent). No correlation was found between BAL pattern and prognosis. Also, BAL pattern was related neither to daily or total dose of Am nor to duration of treatment with Am.

Conclusion: The cellular profile of BAL in Am pneumonitis is highly variable, and no cellular pattern of BAL seems to be predictive of a detrimental outcome or of irreversible fibrosis. Aside from excluding other illnesses, and due to its extreme variability, the contribution of BAL differential in the initial workup of patients suspected of having Am pneumonitis is limited.

Section snippets

PATIENTS AND METHODS

Inpatients and outpatients were recruited from the Departments of Pulmonary and Cardiovascular Diseases of the University Hospital of Dijon, Burgundy. Criteria for Am pneumonitis included the following: long-term (>2 months) treatment with Am, the notion of a normal chest roentgenogram prior to institution of Am therapy, development of new pulmonary opacities while receiving Am, absence of exposure to other pneumotoxicants, reasonable exclusion of other causes for the lung opacities (for the

Clinical Data—Chest Roentgenogram—Pulmonary Function

Fifteen patients (all male) with Am pneumonitis had their condition diagnosed between 1985 and 1991. Eight (patients 1, 3, 4, 6, 7, 8, 9, and 11) were reported earlier as a group in a letter to the editor in French,16 and one patient (patient 9) was described in the English literature.17 Six patients (patients 2, 3, 5, 7, 10, and 14) were never smokers, three (patients 11, 12, and 15) had stopped smoking more than one year earlier, while the six remaining patients (patients 1, 4, 6, 8, 9, and

DISCUSSION

The antiarrhythmic, amiodarone, enjoys popularity among cardiologists worldwide.3 Unfortunately, the drug induces numerous side effects,18 among is which pulmonary toxicity.2 Interestingly, pulmonary toxicity can be reproduced in laboratory animals.19 Despite a huge number of reported cases, no reliable predictive test or diagnostic criteria for Am pneumonitis has yet been identified.2, 20, 21 While an abnormal pretreatment chest roentgenogram or carbon monoxide diffusion test has been regarded

ACKNOWLEDGMENTS

The authors wish to thank Drs. M. Perrichon, A. Prud'homme, and P. Pfitzenmeyer for permission to study and to report details of patients under their care. Mrs. M. Lallemand and R. Trupin gave secretarial assistance. Grant 32* from l'Université de Bourgogne is gratefully acknowledged.

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