Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
Chest. 2013 Apr;143(4):1146-1150. doi: 10.1378/chest.12-0994.
Amiodarone pulmonary toxicity (APT) is the most serious side effect of amiodarone. Although severe APT, such as ARDS, is rare, mortality of severe APT is high. Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is a medical device that reduces blood endotoxin levels in sepsis. Recent reports have shown that PMX-DHP improves oxygenation in patients with acute exacerbation of idiopathic pulmonary fibrosis and drug-induced severe interstitial pneumonia. Here, we present a case study of a patient with severe APT treated with PMX-DHP with complete recovery. The patient rapidly developed respiratory failure and required mechanical ventilation. Despite corticosteroid pulse therapy, no clinical improvement was noted. PMX-DHP was then started, and severe respiratory failure improved with reduction of serum levels of amiodarone and its metabolite monodesethylamiodarone. The patient was weaned from mechanical ventilation and has done well without recurrence. To our knowledge, this is the first reported case of PMX-DHP therapy for severe APT. We speculate that PMX-DHP could be a new treatment strategy for severe APT.
胺碘酮肺毒性（APT）是胺碘酮最严重的副作用。尽管严重的 APT，如 ARDS，很少见，但严重 APT 的死亡率很高。多黏菌素 B 固定纤维柱直接血液灌流（PMX-DHP）是一种降低败血症患者血液内毒素水平的医疗器械。最近的报告表明，PMX-DHP 可改善特发性肺纤维化和药物引起的严重间质性肺炎急性加重患者的氧合。在这里，我们报告了一例使用 PMX-DHP 治疗完全恢复的严重 APT 患者的病例研究。该患者迅速出现呼吸衰竭，需要机械通气。尽管进行了皮质类固醇冲击治疗，但未观察到临床改善。然后开始使用 PMX-DHP，严重的呼吸衰竭随着血清中胺碘酮及其代谢物去乙基胺碘酮水平的降低而改善。患者成功撤机，未再复发，情况良好。据我们所知，这是首例报道的 PMX-DHP 治疗严重 APT 的病例。我们推测 PMX-DHP 可能是治疗严重 APT 的一种新策略。
