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• W2616366604 abstract "To the Editor: We fully agree with Dr. Martin et al about the diagnostic value of bronchoalveolar lavage fluid (BALF) data in assessment of pulmonary damage induced by amiodarone (Chest 1985; 88:630-31); more generally, this is the case for many drug-related pneumonitis.1Akoun GM Mayaud CM Milleron BJ Perrot JY Drug-related pneumonitis and drug-induced hypersensitivity pneumonitis.Lancet. 1984; I: 1362Abstract Scopus (16) Google Scholar Nevertheless the nature of these data merits discussion. In their case report of amiodarone pneumonitis, Dr. Martin et al point to the presence of foamy alveolar macrophages under light microscopic examination and the presence of lamellar inclusions by electron microscopic examination: this is in accordance with the first observations published.2Marchlinski FE Gaensler TS Waxman HL Josephson ME Amiodarone pulmonary toxicity.Ann Intern Med. 1982; 97: 839-845Crossref PubMed Scopus (195) Google Scholar In addition, they state that these “characteristic” inclusions “may reflect an adverse effect of the drug.” However, these inclusions seem to be related to drug impregnation and not necessarily to pulmonary damages. In fact, such inclusions have been described in other phospholipidosis occurring spontaneously or induced by different drugs.3Dake MD Madison MJ Montgomery CK Shellito JE Hinchcliffe WA Winkler ML Bainton DF Electron microscopic demonstration of lysosomal inclusion bodies in lung, liver, lymph nodes, and blood leukocytes of patients with amiodarone pulmonary toxicity.Am J Med. 1985; 78: 506-512Abstract Full Text PDF PubMed Scopus (108) Google Scholar Moreover, these inclusions have been observed in at least 14 patients on amiodarone treatment with no pneumonitis.4Israel-Biet D Venet A Caubarrere I Bonan G Dennewald G Pechaud D Danel C Chretien J Amiodarone pneumonitis mechanism: evaluation by bronchoalveolar lavage (BAL).Am Rev Respir Dis. 1985; 131: A74Google Scholar, 5Liu FL Edelson JD Cohen R Waxman M Cameron D Chapman KR et al.Bronchoalveolar lavage and pulmonary function in amiodarone-induced lung disease.Chest. 1984; 86: 298Google Scholar On the other hand, Dr. Martin et al mention an increase in total cell count in BALF of their patient; surprisingly, the differential cell count was normal. Indeed, in eight patients with amiodarone lung, no changes in differential cell count have been found,5Liu FL Edelson JD Cohen R Waxman M Cameron D Chapman KR et al.Bronchoalveolar lavage and pulmonary function in amiodarone-induced lung disease.Chest. 1984; 86: 298Google Scholar, 6Corns PA Adams PC Wight AJ Morley AR Campbell RWF Gibson GJ Clinical, radiographic, and pathological features of amiodarone pulmonary toxicity.Thorax. 1984; 39: 704-705Google Scholar but in 11 such patients a high grade lymphocyte alveolitis, mainly due to OKT8+ lymphocyte increase has been reported.4Israel-Biet D Venet A Caubarrere I Bonan G Dennewald G Pechaud D Danel C Chretien J Amiodarone pneumonitis mechanism: evaluation by bronchoalveolar lavage (BAL).Am Rev Respir Dis. 1985; 131: A74Google Scholar Similarly, we have underlined that in four out of six such patients, lymphocyte alveolitis had been previously reported.7Akoun GM Gauthier-Rahman S Amiodarone pneumonitis: three further cases with a review of published reports.Thorax. 1984; 39: 800Crossref PubMed Scopus (3) Google Scholar Furthermore, in nine patients on amiodarone treatment but without pneumonitis, there was no differential cell count change in BALF,4Israel-Biet D Venet A Caubarrere I Bonan G Dennewald G Pechaud D Danel C Chretien J Amiodarone pneumonitis mechanism: evaluation by bronchoalveolar lavage (BAL).Am Rev Respir Dis. 1985; 131: A74Google Scholar so these changes seem to be a good indicator of amiodarone-induced pulmonary damages. In summary, in amiodarone lung the presence of lamellar inclusions appear to be relevant to drug impregnation and not to its pulmonary harmful effect; on the other hand, differential cell count changes, never observed in patients on amiodarone treatment with no lung damage, seem to be a more reliable marker for this amiodarone side effect. Amiodarone Pulmonary ToxicityCHESTVol. 89Issue 5PreviewTo the Editor: Full-Text PDF" @default.
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• W2616366604 title "Amiodarone Pulmonary Toxicity" @default.
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