Abstract
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 Warfarin was withdrawn, and antibiotics were started, but bloody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.
Learning objective
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.
Keywords
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Article info
Publication history
Published online: November 09, 2022
Accepted:
October 18,
2022
Received in revised form:
October 7,
2022
Received:
August 5,
2022
Identification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.
