Subcutaneous apomorphine-induced pneumonitis: An uncommon pulmonary adverse event
Abstract
Introduction: Apomorphine is a potent dopaminergic agonist widely used in the management of motor fluctuations in advanced Parkinson's disease. Although generally well tolerated, rare pulmonary adverse drug reactions (ADRs) may occur. We report a case of probable apomorphine-induced pneumonitis associated with subcutaneous administration.
Case presentation: A 62-year-old Caucasian male with multiple comorbidities presented to the emergency department with headache, non-productive cough, central chest pain, fever, and dyspnea over the past 48 hours (3 weeks after initiation of subcutaneous apomorphin). Chest X-ray revealed bilateral hilar infiltrates and basal consolidation. CT scan showed organizing pneumonia (OP)-like pattern. Extensive microbiological evaluation of bronchoalveolar lavage and bronchial aspirate samples, including bacterial, fungal, mycobacterial, viral, and atypical pathogen testing, was negative. Lack of response to broad-spectrum antibiotics raised the suspicion of drug-induced pneumonitis due to subcutaneous apomorphine. Antibiotics were discontinued, and corticosteroid therapy (methylprednisolone 40 mg/day) was initiated with gradual tapering resulted in rapid clinical improvement and complete radiological resolution within one month.
Conclusion: The temporal relationship between apomorphine initiation and symptom onset, compatible clinical and radiological findings, extensive microbiological exclusion of infectious causes, and favorable response after…
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