A rare case of lipoid pneumonia attributed to amiodarone

Ilektra Voulgareli,Dionisios Tsoukalas,George Tsoukalas,Alexandra Chronaiou

doi:10.1186/s41479-018-0056-3

Ilektra Voulgareli, Dionisios Tsoukalas + Show 2 more

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https://doi.org/10.1186/s41479-018-0056-3

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Abstract

We report a case of endogenous lipoid pneumonia secondary to long-term use of amiodarone (> 30 years) for atrial fibrillation in a 76-year-old Caucasian woman, presenting with cough and dyspnea. Endogenous Lipoid pneumonia is a rare underdiagnosed condition more prevalent in adults. It is usually asymptomatic and a diagnosis is generally made in patients who have become clinically unstable or when an abnormal lung shadow is found on a chest X-ray. In the case here described it was diagnosed by fiberoptic bronchoscopy with bronchoalveolar lavage (BALF) where fat-laden macrophages (oil red O stain) were identified. Since a history of use of oil-based products had been ruled out, amiodarone was deemed to be the most likely cause of lipoid pneumonia. The patient was managed with the replacement of amiodarone with digoxin and treated with oral prednisolone. The patient has remained clinically stable with radiological improvement during a follow-up of two years.

Highlights

Endogenous lipoid pneumonia is an uncommon clinical condition, more prevalent in adult age, but generally underdiagnosed
We report the case of a 76-year-old woman who was diagnosed with endogenous lipoid pneumonia attributed to chronic use of amiodarone (30 years) and successfully treated with discontinuation of amiodarone and prescription of prednisolone
Endogenous lipoid pneumonia can be associated with systemic diseases such as rheumatoid arthritis, Hodgkin’s lymphoma, and Wegener’s granulomatosis

Summary

Introduction

Endogenous lipoid pneumonia is an uncommon clinical condition, more prevalent in adult age, but generally underdiagnosed It can be associated with bronchial obstruction [1], systemic diseases such as rheumatoid arthritis, Hodgkin’s lymphoma, and Wegener’s granulomatosis or it can be idiopathic [2]. The patient was a nonsmoker and had worked for a few years in a cotton factory Her past medical history was negative for any contact with substances known to be associated with lipoid pneumonia. Vital signs were within normal range with SpO2 of 95% in room air Her physical examination revealed bibasal lung crackles, but no evidence of pallor, icterus, cyanosis, clubbing or lymphadenopathy. The patient had been taking amiodarone (200 mg OD) for 30 years which was considered the most likely cause It was discontinued and replaced with digoxin (0.25 mg OD) for the treatment of atrial fibrillation. She was started on oral prednisolone (20 mg OD) which was gradually tapered over a period of six months

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