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Lung-nontumor

Other interstitial pneumonitis / fibrosis

Amiodarone induced pulmonary toxicity


Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 24 September 2011, last major update September 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Oral antiarrythmic drug, usually used long term
● 5-10% of patients develop lung injury
● Risk factors are: advanced age, higher dose therapy, lung surgery, oxygen therapy and underlying pulmonary disease; disease may occur without risk factors or at lower doses
● Drug inhibits phospholipid degradation by lysosomes, resulting in phospholipid accumulation within cells, especially alveolar macrophages

Case reports
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● 68 year old man with amiodarone induced pulmonary toxicity (Arch Pathol Lab Med 2002;126:745)

Treatment
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● Drug withdrawal or dose reduction, corticosteroid therapy
● May have 50% mortality if diffuse alveolar damage is present

Micro description
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● Intra-alveolar exudate of finely vacuolated foamy macrophages, also present within alveolar septa
● May have diffuse alveolar damage, cryptogenic organizing pneumonia type changes or changes of non-specific interstitial pneumonia or desquamative interstitial pneumonia

Micro images
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Various images

Cytology description
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● Finely vacuolated, foamy macrophages; variable neutrophils

EM description
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● Membrane-bound cytoplasmic lamellar inclusions due to drug accumulation in the lungs
● Morphologic findings are not specific and must be interpreted in conjunction with the clinical history

End of Lung-nontumor > Other interstitial pneumonitis / fibrosis > Amiodarone induced pulmonary toxicity


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