Walterspacher Stephan, Windisch Wolfram, Zissel Gernot, Saurbier Bernward, Sorichter Stephan
University Clinic Freiburg, Department of Pneumology, Freiburg, Germany.
Ger Med Sci. 2005 Jun 1;3:Doc03.
Patients undergoing treatment with amiodarone can develop severe pulmonary side effects. This effect, which is often highly underestimated, can lead to dyspnea, pneumonitis, and further fibrosis. A recent change in the labeling of amdiodarone by the American Food and Drug Administration (FDA) supports this suspicion. Tracing the symptoms back to the causing agent can be difficult, as shown in our report. The subject of this case report is an endurance-trained 65 year old male marathon runner who appeared with atrial fibrillation during a routine check up in autumn 2003. After medical cardioversion with flecainide a complaint free interval of 8 months was followed by a relapse, which resulted in a change of medication to amiodarone. Due to misunderstandings the patient kept on taking the amiodarone loading dose for six weeks and returned with severe dyspnea on exertion. Losses in CO diffusing capacity, a lowered macrophages count and a positive lymphocyte transformation test were the only first hand clinical evidence of amiodarone intoxication, despite the sensation of dyspnea. This case shows that special care has to be taken in treatment with amiodarone. Side effects can be hard to trace and do not evidently show a clear connection to amiodarone.
接受胺碘酮治疗的患者可能会出现严重的肺部副作用。这种效应往往被严重低估，可能导致呼吸困难、肺炎及进一步的纤维化。美国食品药品监督管理局（FDA）最近对胺碘酮标签的更改证实了这一疑虑。正如我们的报告所示，将症状追溯至致病因素可能很困难。本病例报告的对象是一名65岁、接受过耐力训练的男性马拉松运动员，他在2003年秋季的一次常规体检中出现房颤。在使用氟卡尼进行药物心脏复律后，有8个月无症状期，随后复发，于是改用胺碘酮治疗。由于误解，患者持续服用胺碘酮负荷剂量达六周，之后因运动时严重呼吸困难前来复诊。尽管有呼吸困难的症状，但一氧化碳弥散量降低、巨噬细胞计数减少以及淋巴细胞转化试验呈阳性是胺碘酮中毒仅有的第一手临床证据。该病例表明，使用胺碘酮治疗时必须格外小心。副作用可能难以追查，且与胺碘酮之间没有明显的直接关联。
