Anai Satoshi, Nakayama Yuri, Gushiken Hiroki, Chinen Shigeki, Masuda Keita, Kamiya Hiroki, Ueno Shiho, Maeda Minetaka, Kiyuna Masaya, Sato Yoko, Matsumoto Tsuyoshi
Division of Respiratory Medicine, Yuuai Medical Center, Tomishiro City, Okinawa, Japan.
Division of Cardiology, Yuuai Medical Center, Tomishiro City, Okinawa, Japan.
J Cardiol Cases. 2022 Nov 10;27(3):93-96. doi: 10.1016/j.jccase.2022.10.012. eCollection 2023 Mar.
A 56-year-old man presented with fever, cough, and bloody sputum. He had undergone mitral valve replacement with mechanical prosthesis 14 months prior for mitral valve disease. Subsequently, the patient was taking warfarin and amiodarone. Chest imaging revealed dense, infiltrative shadows, and blood tests showed prolonged prothrombin time and eosinophilia. Warfarin was withdrawn, and antibiotics were started, but bloody sputum and respiratory failure persisted. Considering that eosinophilia was observed after the administration of amiodarone, the drug was discontinued, and bronchoalveolar lavage was performed. Cytology showed foam cells, eosinophils, and hemosiderin-laden macrophages; amiodarone-induced diffuse alveolar hemorrhage (DAH) and acute eosinophilic pneumonia (AEP) were diagnosed, and the patient was treated with corticosteroids. This report describes the first documented case of amiodarone-induced DAH and AEP. When a patient taking amiodarone presents with antibiotic-refractory pneumonia with bloody sputum and eosinophilia, amiodarone-induced DAH and AEP should be considered.
We report the first case of amiodarone-induced diffuse alveolar hemorrhage (DAH) and acute eosinophilic pneumonia (AEP) diagnosed by foam cells, eosinophils, and hemosiderin-laden macrophages on bronchoalveolar lavage cytology. When a patient taking amiodarone presents with antibiotic-refractory pneumonia with bloody sputum and eosinophilia, amiodarone-induced DAH and AEP should be considered.
一名56岁男性出现发热、咳嗽和咯血痰症状。他在14个月前因二尖瓣疾病接受了机械瓣膜二尖瓣置换术。术后，患者一直在服用华法林和胺碘酮。胸部影像学检查发现有致密的浸润性阴影，血液检查显示凝血酶原时间延长和嗜酸性粒细胞增多。停用了华法林并开始使用抗生素，但咯血痰和呼吸衰竭仍持续存在。考虑到在使用胺碘酮后出现了嗜酸性粒细胞增多，遂停用该药物并进行了支气管肺泡灌洗。细胞学检查显示有泡沫细胞、嗜酸性粒细胞和含铁血黄素巨噬细胞；诊断为胺碘酮诱发的弥漫性肺泡出血（DAH）和急性嗜酸性粒细胞性肺炎（AEP），患者接受了糖皮质激素治疗。本报告描述了首例有文献记载的胺碘酮诱发的DAH和AEP病例。当服用胺碘酮的患者出现抗生素难治性肺炎伴咯血痰和嗜酸性粒细胞增多时，应考虑胺碘酮诱发的DAH和AEP。
我们报告了首例通过支气管肺泡灌洗细胞学检查发现泡沫细胞、嗜酸性粒细胞和含铁血黄素巨噬细胞而诊断的胺碘酮诱发的弥漫性肺泡出血（DAH）和急性嗜酸性粒细胞性肺炎（AEP）病例。当服用胺碘酮的患者出现抗生素难治性肺炎伴咯血痰和嗜酸性粒细胞增多时，应考虑胺碘酮诱发的DAH和AEP。
