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Cryptogenic organizing pneumonia due to amiodarone: long-term follow-up after corticosteroid treatment

Kryptogene organisierende Pneumonie nach Amiodaron-Behandlung: Langzeitverlauf nach Corticosteroidbehandlung

Zusammenfassung

Das Krankheitsbild der kryptogen organisierenden Pneumonie (früher bekannt als Bronchiolitis obliterans mit organisierender Pneumonie) ist eine Entität mit charakteristischen klinischen, pathologischen und radiologischen Befunden. Röntgenologisch finden sich meist bilaterale, asymmetrische, teilweise wandernde fleckige Infiltrate, die sich im CT als Milchglasverschattungen darstellen. Das Syndrom wurde im Zusammenhang mit gastrointestinalen Erkrankungen, Lungeninfektionen, Autoimmunerkrankungen (z.B. Wegener Granulomatose), der Inhalation von giftigen Dämpfen sowie nach Knochenmarkstransplantation und Gabe bestimmter Medikamente beobachtet. Das bei Vorhofflimmern häufig als Antiarrythmikum angewandte Benzofuran Amiodaron hat diverse mögliche pulmonale Nebenwirkungen und Folgeerkrankungen. Die kryptogen organisierende Pneumonie wurde in diesem Zusammenhang bisher selten diagnostiziert und publiziert. Wir berichten über einen Fall von Amiodaron-induzierter kryptogen organisierender Pneumonie, dessen klinischer Verlauf durch eine signifikante Besserung der klinischen Symptomatik nach Absetzen von Amiodaron und Etablierung einer Corticoidtherapie bereits nach wenigen Tagen gekennzeichnet war. Auch die im Thoraxröntgen und CT festgestellten Infiltrate zeigten ein gutes Ansprechen mit rascher Rückbildungstendenz. Während der fünfmonatigen Corticoidtherapie bildeten sich die pulmonalen Veränderungen schrittweise fast vollständig zurück und blieben auch während des 8-monatigen Beobachtungszeitraumes nach Beendigung der Therapie stabil.

Summary

Cryptogenic organizing pneumonia (formerly known as bronchiolitis obliterans organizing pneumonia) is a clinicopathological entity with characteristical radiographic findings such as bilateral, asymmetrical, sometimes migrating, patchy infiltrates in chest radiograph and ground-glass opacities in computed tomography. The disease has been observed in the context of gastrointestinal disorders, certain lung infections, autoimmune-mediated diseases (such as Wegener granulomatosis), inhalation of toxic fumes, bone marrow transplantation and administration of drugs. The benzofuran amiodarone, a commonly used antiarrythmic drug for atrial fibrillation, can exhibit several pulmonary adverse effects, amongst them cryptogenic organizing pneumonia as a rarely diagnosed and published one. We report a case of cryptogenic organizing pneumonia secondary to amiodarone treatment, its clinical course with significant improvement of clinical symptoms within a few days after discontinuation of amiodarone treatment and administration of corticosteroids. Also the infiltrations found in chest X-ray and computed tomography responded well and showed remarkable resolution tendency quickly. During 5 months of corticoid therapy pulmonary abnormalities gradually resolved almost completely and remained equal during the 8 months follow-up after corticoid termination.

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Correspondence to Katja Schindler.

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Schindler, K., Schima, W. & Kaliman, J. Cryptogenic organizing pneumonia due to amiodarone: long-term follow-up after corticosteroid treatment. Wien Klin Wochenschr 122, 511–514 (2010). https://doi.org/10.1007/s00508-010-1412-3

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Keywords

  • Amiodarone
  • Cryptogenic organizing pneumonia
  • Toxicity
  • HRCT
  • Interstitial lung disease