Amiodarone Induced Bone Marrow Granulomas: A Literature Review of Case Reports

Abstract

Amiodarone Induced Bone Marrow Granulomas: A literature Review of Case reports Background Amiodarone is classified as a class III antiarrhythmic drug primarily indicated in the treatment of ventricular arrhythmias. The agent has a wide array of adverse effects that may affect multiple organ systems, including the pulmonary, central nervous system, cardiovascular, thyroid, liver, eyes, and skin. A rare and uncommon occurrence from amiodarone use is the development of bone marrow granulomas. This review article summarizes the mechanism of action, clinical uses of amiodarone therapy and reviews the unique presentation of amiodarone-associated bone marrow granulomas using ten case reports. It also includes a discussion section summarizing literature that can further aid healthcare professionals and patients in the diagnosis, management, and education of this adverse effect. Methods An electronic database search of scientific platforms such as PubMed, Pubmed Central (PMC), and Google Scholar was conducted. Respective data was collected and reviewed to conduct this manuscript. 10 previously published case reports regarding amiodarone induced bone marrow granulomas were analyzed and reported. Articles were selected based on the keywords mentioned above. Results As per the reported cases of amiodarone- associated granulomas, subjects taking a dosage of 100 mg – 200 mg for a duration of 6 to 18 months was enough to ensure bone marrow granulomas. Repeated bone marrow biopsy 3 to 6 months after discontinuation of the offending agent demonstrated an improvement. All ten case reports revealed noncaseating granulomas confirmed by bone marrow biopsy. Subjects that did develop cases of anemia, EPO showed great improvements to raise Hb levels. 4 of the 10 cases continued treatment despite the confirmed bone marrow granulomas due to the intractable nature of their cardiac condition. In such cases, routine monitoring is recommended, and repeated bone marrow biopsies may be required. Conclusion Bone marrow granulomas are seen commonly in infectious and malignant etiologies. A thorough history and workup can reveal uncommon causes such as medication-induced and prevent misdiagnosis. Bone marrow granulomas in subjects previously receiving treatment with amiodarone should arouse clinical suspicion for possible drug-induced etiology.