Abstract 4364158: A Ticking Time Bomb, Acute Amiodarone-Induced Pulmonary Toxicity Leading to ARDS in a Nonagenarian: A Case Report
Abstract
Amiodarone is an iodine-containing antiarrhythmic agent commonly used to manage ventricular and supraventricular arrhythmias. Despite its clinical efficacy, amiodarone has a well-documented side effect profile due to its lipophilic nature and tendency to accumulate in various organs. Amiodarone-induced pulmonary toxicity (APT) occurs in approximately 1–5% of patients, with acute presentations being rare (<1%). Acute APT typically presents as respiratory failure and, if not recognized promptly, can progress rapidly to acute respiratory distress syndrome (ARDS), which carries a mortality rate of nearly 50%, in contrast to a 10% mortality rate in subacute or chronic forms.
We present the case of a 91-year-old woman with a history of persistent atrial fibrillation, HFpEF, hypertension, and peripheral vascular disease who presented with acute hypoxic respiratory failure while in atrial fibrillation. Within the same month, she was started on amiodarone 200 mg daily and subsequently underwent TEE-guided cardioversion. High-resolution chest CT on admission revealed new, extensive bilateral pulmonary infiltrates. She was admitted to the ICU, amiodarone was discontinued, and treated with diltiazem, digoxin, steroids, and empiric antibiotics under an ARDS protocol. DNAR/DNI status led to non-invasive ventilatory support. Bronchoscopy with BAL was negative for infection or malignancy; cytology revealed foamy macrophages. PFT showed a restrictive pattern and reduced DLCO. Her condition…
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