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. 2005 Jun 1:3:Doc03.

Acute lung affection in an endurance-trained man under amiodarone medication

Stephan Walterspacher  1 , Wolfram Windisch, Gernot Zissel, Bernward Saurbier, Stephan Sorichter
Affiliations

Acute lung affection in an endurance-trained man under amiodarone medication

Stephan Walterspacher et al. Ger Med Sci. .

Abstract
in English, German

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.

Wir beschreiben den Fall eines 65-jährigen Ausdauersportlers, der sich im Herbst 2003 mit Vorhofflimmern vorstellte. Nach medikamentöser Kardioversion mit Flecainid folgte ein beschwerdefreies Intervall von acht Monaten. Rezidive des Vorhofflimmerns erforderten die Umstellung auf Amiodaron. Aufgrund von Missverständnissen nahm der Patient die Aufsättigungsdosis über einen Zeitraum von sechs Wochen ein, wobei die ersten vier Wochen beschwerdefrei verliefen und sich über die nächsten zwei Wochen eine ausgeprägte Atemnot entwickelte. Dieser Fallbericht zeigt, dass die Behandlung mit Amiodaron besonderer Sorgfalt bedarf. Nebenwirkungen sind bisweilen sehr schwer erkennbar und zeigen nicht immer eine klare Beziehung zu der Amiodaroneinnahme.

Keywords: amiodarone; dyspnoe; pneumonitis; vital capacity.

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Figures

Figure 1
Figure 1. DLCO (%), VC max (%) and FEV1 (%) in a male subject with acute amiodarone pneumonitis before and after cessation of therapy (August 12, 2004).
Values in % of normal value.
See this image and copyright information in PMC

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