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• W2895059128 abstract "SESSION TITLE: Diffuse Lung Disease 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: With a multitude of causes, diffuse alveolar hemorrhage is caused disruption of alveolar-capillary basement membrane. Sequential broncho-alveolar lavage showing progressively more hemorrhagic effluent is characteristic. Cessation of implicated drugs, treatment of infection, and reversal of excess anticoagulation are key. CASE PRESENTATION: We present a case of 67-year-old gentleman with prior history of hypertension, sleep apnea and recently diagnosed atrial fibrillation on amiodarone and dabigatran who presented to the hospital with progressive shortness of breath, cough and wheezing for 1 week. Found to be tachypneic (RR 40/min) and hypoxemic (SpO2 81% on 15 Lpm), the patient was placed on BiPAP to maintain his SpO2 > 90%. Chest X-ray revealed bilateral diffuse infiltrates and CT showed extensive bilateral patchy ground glass opacities. His blood work revealed leukocytosis at 21000.The patient was intubated for increased work of breathing and put on high PEEP/low tidal volume per ARDSnet ventilation strategy. He underwent urgent bronchoscopy which revealed non-resolving sero-sanguineous secretions throughout the tracheobronchial tree, during serial lavages, otherwise negative for bacterial / fungal infections or malignancy. The patient was continued on broad spectrum antibiotics and administered Idarucizumab. The cytopathology on BAL fluid was positive for abundant foamy macrophages with electron micrographs positive for cytoplasmic lamellar inclusions consistent with amiodarone toxicity.The patient had a prolonged hospital stay complicated by a bilateral lower extremity DVT requiring an IVC filter placement, ICU delirium and critical illness myopathy. Post extubation on day 20, he became acutely ill with septic shock with Pseudomonas bacteremia and acute ischemic colitis. The patient needed re-intubation for airway protection, but the patient was made DNR and eventually died from the same. DISCUSSION: Less than 20 cases of DAH secondary to amiodarone have been described in literature. With increasing prevalence of atrial fibrillation and expanding indications for novel oral anticoagulants, it is imperative that clinicians are familiar with this complication. Phospholipid degradation with lipid –laden macrophages, lipid peroxidation, free radical generation are the presumed pathways of pulmonary interstitial inflammation. The heterogeneity and infrequency of this complication does not allow for accurate risk assessment or mortality predictions. CONCLUSIONS: Amiodarone induced pulmonary toxicity resulting in diffuse alveolar hemorrhage is uncommon. This requires a high index of clinical suspicion especially since many of these patients are on oral anticoagulants as well. Reference #1: Diffuse Alveolar Hemorrhage: Who Is the Culprit?; American Journal of Respiratory and Critical Care Medicine 2017;195:A5536 Reference #2: A Rare Case of Acute Diffuse Alveolar Hemorrhage FollowingInitiation of Amiodarone: A Case Report; MILITARY MEDICINE, 177, 1:118, 2012 Reference #3: Amiodarone-induced alveolar haemorrhage: a rare complication of a common medication; Heart Lung Circ. 2010 Jul;19(7):435-7. https://doi.org/10.1016/j.hlc.2010.01.008 DISCLOSURES: No relevant relationships by Himmat Grewal, source=Web Response No relevant relationships by Abhijai Singh, source=Web Response No relevant relationships by Simant Thapa, source=Web Response" @default.
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• W2895059128 date "2018-10-01" @default.
• W2895059128 modified "2023-09-27" @default.
• W2895059128 title "AM I DROWNING IN BLOOD? OR AMIO-DARONING?" @default.
• W2895059128 doi "https://doi.org/10.1016/j.chest.2018.08.384" @default.
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