ACUTE AMIODARONE TOXICITY PRESENTING AS A LUNG MASS

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: We present a very uncommon case of lung mass developed within month starting amiodarone in an elderly male. CASE PRESENTATION: An 82-year-old male with past medical history end-stage renal disease on hemodialysis, congestive heart failure, diabetes mellitus, coronary artery disease, atrial fibrillation (200mg/day started ago) presented dry cough and altered mental status for one day. On exam, he appeared tachypneic drowsy mild bibasilar lungs crackles. Laboratory findings included WBCs 4.8 K/UL, procalcitonin 0.3 ng/ML sterile blood, urine, respiratory cultures. Chest x-ray showed new right upper lobe opacity persistent bilateral lower lobes congestion (figure 1a). Computerized tomography (CT) the chest dense, irregular soft tissue high attenuation at apex adjacent smaller spiculated nodules compatible deposition 1b). Pulmonary cardiology services advised stopping no further intervention. Bronchoscopy biopsy were not done due to poor cardiac function. He was discharged nursing home after significant improvement his symptoms. follow up year, patient had complete resolution DISCUSSION: Amiodarone is widely used iodinated antiarrhythmic agent side effects its various organs including (4-17%). Organ toxicity may occur from direct cytotoxicity or T-cell mediated hypersensitivity reaction. Though there safe dose, associated pulmonary mostly suspected patients taking daily dose 400 mg more than 2 months any years [1,2]. Life-threatening irreversible frequently older age, longer duration treatment, dosage, pre-existing disease. Diagnosis made exclusion other causes presenting nonproductive and/or dyspnea, imaging findings, showing lipid-laden foamy macrophages. Once identified, noted withdrawal drug. Several patterns inflammation interstitial organizing pneumonia, pleural effusion, nodule, mass-like lesions are evident [3]. High density (> 80 Hounsfield units) iodinated-amiodarone accumulation appreciated high-resolution CT typical as seen our The mainstay treatment includes discontinuation drug without oral steroids. Patient education, regular use lowest effective doses key reducing adverse CONCLUSIONS: Given condition reversible curable; author wants highlight importance early diagnosis favorable prognosis. REFERENCE #1: Jessurun GA, Crijns HJ. toxicity. BMJ. 1997;314(7081):619-620. doi:10.1136/bmj.314.7081.619 #2: Schwaiblmair, M., Berghaus, T., Haeckel, T. et al. Amiodarone-induced toxicity: under-recognized severe effect?. Clin Res Cardiol 99, 693–700 (2010). https://doi.org/10.1007/s00392-010-0181-3 #3: Jarand J, Lee A, Leigh R. Amiodaronoma: unusual form amiodarone-induced CMAJ. 2007;176(10):1411-1413. doi:10.1503/cmaj.061102 DISCLOSURES: No relevant relationships by Kabu Chawla, source=Web Response Resha Khanal, Sharad Oli, Shital Shaurya Sharma,