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• W3092912071 abstract "SESSION TITLE: Medical Student/Resident Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Organizing pneumonia (OP) is a type of diffuse interstitial lung disease that affects the distal bronchioles, respiratory bronchioles, alveolar ducts, and alveolar walls. Secondary OP may be seen in associations with a variety of drugs. Here we discuss a rare case of OP secondary to amlodipine overdose. CASE PRESENTATION: A 54-year-old male with past medical history of hypertension presented to the emergency room (ER) with complaints of nausea and chest pain for 6 hours following an intentional overdose of 70 amlodipine tablets after a dispute with his wife. Initial ER vitals showed tachycardia and hypotension with otherwise normal vitals. Examination was benign except for bibasal crackles heard on the respiratory exam. Initial lab investigations were significant for white blood cells (WBC) 11.9 x 109, creatinine 1.86, calcium 10 with repeat 8.8, lactic acid 3.2, amylase 119 and lipase 83. Chest x-ray showed diffuse bilateral haziness of the lung parenchyma suggesting pulmonary edema or diffuse infiltrates. Computer tomography (CT) abdomen showed peripancreatic inflammation and moderate bibasilar lung disease. He was admitted to the intensive care unit (ICU) with acute hypoxic respiratory failure requiring noninvasive ventilation (NIV) and hypotension in the setting of amlodipine overdose. He was treated with intravenous fluids, glucagon and calcium gluconate. His ICU course was complicated by mildly elevated troponins with normal electrocardiogram and echocardiogram. Despite resolution of hypotension, his hypoxemia persisted. In view of his leukocytosis he was treated empirically with ceftriaxone, azithromycin and clindamycin. Bronchoscopy with biopsy later revealed OP. Final blood and respiratory cultures were all no growth. On discharge, he was normotensive and amlodipine discontinued. On follow-up his collagen vascular screen, HIV and acid-fast bacillus cultures were unremarkable. CT chest 6 months post discharge showed complete resolution of bibasilar lung consolidation. DISCUSSION: Organizing pneumonia is a consequence of alveolar epithelial injury which may be secondary to collagen vascular disease, infections, malignancies and drugs. More than 20 medications are associated with the OP, with the strongest associations with amiodarone, minocycline and nitrofurantoin. In this case, our patient had an acute onset of symptoms following amlodipine overdose with no overt known causes for OP. To date, there is one case report of organizing pneumonia secondary to nifedipine in a patient with Sjogren's. The early identification and discontinuation of this relatively safe drug, amlodipine, represents an essential tenet of therapy in organizing pneumonia. CONCLUSIONS: To date there has been no recorded associations between amlodipine and OP. This association may have been seen due to diffuse alveolar injury in the setting of overdose with profound hypotension and ischemia. Reference #1: Hofer, C. A., Smith, J. K., & Tenholder, M. F. (1993). Verapamil intoxication: A literature review of overdoses and discussion of therapeutic options. The American Journal of Medicine, 95(4), 431–438. https://doi.org/10.1016/0002-9343(9390314-f) Reference #2: Epler, G. R. (2001). Bronchiolitis Obliterans Organizing Pneumonia. Archives of Internal Medicine, 161(2), 158. https://doi.org/10.1001/archinte.161.2.158 Reference #3: Ryu, J. H., Myers, J. L., & Swensen, S. J. (2003). Bronchiolar Disorders. American Journal of Respiratory and Critical Care Medicine, 168(11), 1277–1292. https://doi.org/10.1164/rccm.200301-053so DISCLOSURES: No relevant relationships by kimberley cousins, source=Web Response No relevant relationships by Sahai Donaldson, source=Web Response No relevant relationships by Lorenzo Leys, source=Web Response No relevant relationships by Vishal Poddar, source=Web Response No relevant relationships by Lamiaa Rougui, source=Web Response" @default.
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• W3092912071 date "2020-10-01" @default.
• W3092912071 modified "2023-09-25" @default.
• W3092912071 title "RARE CASE OF AMLODIPINE-INDUCED ORGANIZING PNEUMONIA" @default.
• W3092912071 doi "https://doi.org/10.1016/j.chest.2020.09.173" @default.
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