Melih BÜYÜKŞİRİN, Ceyda ANAR, Günhan YAVAŞOĞLU, Hüseyin HALİLÇOLAR, Nur YÜCEL

KİTLE ŞEKLİNDE PREZENTE OLAN AMIODARONA BAĞLI BİR ORGANİZE PNÖMONİ OLGUSU

Amiodaron pulmoner fibrozise gidebilecek intertisyel pnömoniye neden olan antiaritmik bir ilaçtır. Altmış dört yaşında dispne, ateş, öksürük yakınması ile başvuran erkek hastanın özgeçmişinden amiodaron, metoprolol ve aspirin ilaçlarını kullandığı öğrenildi. Yüksek rezolüsyonlu bilgisayarlı tomografisinde (YRBT) bilateral üst loblarda lokalize konsolidasyon görünümlü lezyonların olması ve tru-cut doku biyopsisinin organize pnömoni olarak yorumlanması sonucunda hastada amiodarona bağlı pulmoner toksisite düşünüldü. Steroid tedavisi başlandıktan üç ay sonra çekilen göğüs radyogramında tam regresyon izlendi. Bu olguda YRBT'de amiodaron toksisitesinin en sık görülen bulgusu olan bilateral intertisyel infiltratlar yerine daha nadir görülen iyi lokalize edilen kitle ve konsolidasyon görünümlerin de olabileceği vurgulanmıştır. Ayrıca solunum sistemi yakınmaları ile gelen hastalarda öykü alırken kullanmakta olduğu ilaçları detaylı bir şekilde sorgulamakta yarar olduğunu düşünmekteyiz.

Anahtar Kelimeler:

Amiodaron, organize pnömoni, akciğer, konsolidasyon, kitle, toksisite

A CASE OF AMIODARONE INDUCED ORGANIZING PNEUMONIA PRESENTING AS A PULMONARY MASS

Amiodarone is an antiarrhythmic drug that can cause interstitial pneumonitis leading to pulmonary fibrosis. Amiodarone, metoprolol, and aspirin drugs had been used by a 64 year old man who admitted with dyspnea, fever, cough. Bilateral localized consolidation lesion was in upper lobes in high resolution computed tomography ( HRCT) and tru- cut tissue biyopsy was reported as organizing pneumonia; so amiodarone-induced pulmonary toxicity was thought in the patient. Three months after cessation of steroid treatment, chest radyogram shows complete regression of pneumonitis. The present case report demonstrates the localized mass, and consolidation lesions that is seen very rare instead of bilateral interstitial infiltrates that is the most common HRCT findings of amiodarone toxicity. In addition, we thougt that drugs that has been used must cross-examine in detail in the patients admitted with respiratory symptoms.

Keywords:

Amiodaron, organizing pneumonia, pulmonary, consolidation, mass, toxicity,

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1. Marcus FI, Fontaine R, Grosgogeat Y. Clinical pulmonary and therapeutic of the antiarrhythmic agent, amiodarone. Am Heart J 1981; 101: 480-93.
2. Kennedy JI, Myers JL, Plumb VJ, Fulmer JD. Amiodarone pulmonary toxicity. Arch Intern Med 1987; 147: 50-5.
3. Sobol SM, Rakita L. Pneumonitis and pulmonary fibrosis associated with amiodarone treatment: A possible complication of a new antiarrhythmic drug. Circulation 1982; 65: 819-24.
4. Piazza I, Bizzaro N. A localized pleuropulmonary lesion induced by long-term therapy with amiodarone. Respiration 1992; 59: 185-8.
5. Martin WJ, Rosenow EC. Amiodarone pulmonary toxicity. Chest 1988; 93: 1245-8.
6. Dusman RE, Stanton MS, Miles WM, et al. Clinical features of amiodarone-induced pulmonary toxicity. Circulation 1980; 82: 51-9.
7. Martin WJ, Rosenow EC. Amiodarone pulmonary toxicity: Recognition and pathogenesis. Chest 1988; 93: 1067-75.
8. Vizioli LD, Cho S. Amiodarone-associated hemoptysis. Chest 1994; 105: 305-6.
9. Camus P, Martin WJ II, Rosenow EC III. Amiodarone pulmonary toxicity. Clin Chest Med 2004; 25: 65-75.
10. Dean PJ, Groshart KD, Porterfield JG. Amiodarone associated pulmonary toxicity. A clinical and pathologic study of eleven cases. Am J Clin Pathol 1987; 87: 7-13.
11. Jarand J, Lee A, Leigh R. Amiodaroma: An unusual form of amiodarone-induced pulmonary toxicity. CMAJ 2007; 176: 1411-3.
12. Azzam I, Tov N, Elias N, et al. Amiodarone toxicity presenting as a pulmonary mass and peripheral neuropathy: The continuing diagnostic challenge. Postgrad Med J 2006; 82: 73-5.
13. Poll LW, May P, Koch JA, et al. HRCT findings of amiodarone pulmonary toxicity: Clinical and radiologic regression. J Cardiovasc Pharmacol Ther 2001; 6: 307-11.
14. Shi JH, Liu HR, Zhu YJ, Xu WB. Clinicopathologic manifestation of amiodarone-induced lung injury. Zhonghua Bing Li Xue Za Zhi. 2006; 35: 394-7.
15. Dirlik A, Erinc R, Ozcan Z, et al. Technetium99m-DTPAaerosol scintigraphy in amiodarone induced pulmonary toxicity in comparison with Ga-67 scintigraphy. Ann Nucl Med 2002; 16: 477-81.
16. Durmus-Altun G, Altun A, Aktas RG, et al. Use of iodine-123 metaiodobenzylguanidine scintigraphy for the detection of amiodarone induced pulmonary toxicity in a rabbit model: A comparative study with technetium- 99m diethyltriaminepenta acetic acid radioaerosol scintigraphy. Ann Nucl Med 2005; 19: 217-24.