PP-59 - An Unusual Case of Asymptomatic Diffuse Alveolar Hemorrhage Related to Amiodarone Induced INR Elevation

Abstract

Abstract: Pulmonary adverse effects of amiodarone is an important cause of morbidity. Despite pulmonary toxicity occurs as pneumonitis, rarely, it may also occur as diffuse alveolar hemorrhage. Another important amiodarone-induced adverse effect is hepatotoxicity. Hepatotoxicity mostly presents as asymptomatic elevation of liver enzymes. To the best of our knowledge, in amiodarone-induced hepatotoxicity AST, ALT elevation is well known, however, there is no clear data about high International normalized ratio (INR) level in this condition. In this case report, a patient was presented under management of chronic low-dose amiodarone who admitted to emergency department for hematoma on his tongue. During the assessment for bleeding diathesis, INR was found to be 8.59. All other causes were excluded for high INR level in this case and amiodarone was related to high INR level. Since there were diffuse infiltrations on chest X-ray, the patient underwent thorax tomography. Asymptomatic diffuse alveolar hemorrhage secondary to INR elevation was considered. This patient is the first case who had amiodarone-induced INR elevation, and as a consequence, developed asymptomatic diffuse alveolar hemorrhage.