Trepopnea due to amiodarone-induced diffuse alveolar hemorrhage.

Diffuse hemorrhage is a known but infrequent complication of amiodarone pulmonary toxicity and a cause of hemoptysis, with 12 cases reported up to now. Unlike other form of amiodarone pulmonary toxicity, early or very early1 onset seems to be common. It is thought to be mistaken for acute heart failure in many patients, due to similar clinical pattern and concomitant use of anti-aggregants or anticoagulants.2 Trepopnea refers to dyspnea that occurs in one lateral decubitus position. Trepopnea has been described in several conditions (Table 1), but there are no previous reports in patients with diffuse alveolar hemorrhage. We report a patient with hemoptysis and trepopnea due to amiodarone pulmonary toxicity, discuss characteristics of this infrequent complication of amiodarone treatment, and comment about the possible usefulness of trepopnea, if present, to suspect this condition.