Zusammenfassung
Das Krankheitsbild der kryptogen organisierenden Pneumonie (früher bekannt als Bronchiolitis obliterans mit organisierender Pneumonie) ist eine Entität mit charakteristischen klinischen, pathologischen und radiologischen Befunden. Röntgenologisch finden sich meist bilaterale, asymmetrische, teilweise wandernde fleckige Infiltrate, die sich im CT als Milchglasverschattungen darstellen. Das Syndrom wurde im Zusammenhang mit gastrointestinalen Erkrankungen, Lungeninfektionen, Autoimmunerkrankungen (z.B. Wegener Granulomatose), der Inhalation von giftigen Dämpfen sowie nach Knochenmarkstransplantation und Gabe bestimmter Medikamente beobachtet. Das bei Vorhofflimmern häufig als Antiarrythmikum angewandte Benzofuran Amiodaron hat diverse mögliche pulmonale Nebenwirkungen und Folgeerkrankungen. Die kryptogen organisierende Pneumonie wurde in diesem Zusammenhang bisher selten diagnostiziert und publiziert. Wir berichten über einen Fall von Amiodaron-induzierter kryptogen organisierender Pneumonie, dessen klinischer Verlauf durch eine signifikante Besserung der klinischen Symptomatik nach Absetzen von Amiodaron und Etablierung einer Corticoidtherapie bereits nach wenigen Tagen gekennzeichnet war. Auch die im Thoraxröntgen und CT festgestellten Infiltrate zeigten ein gutes Ansprechen mit rascher Rückbildungstendenz. Während der fünfmonatigen Corticoidtherapie bildeten sich die pulmonalen Veränderungen schrittweise fast vollständig zurück und blieben auch während des 8-monatigen Beobachtungszeitraumes nach Beendigung der Therapie stabil.
Summary
Cryptogenic organizing pneumonia (formerly known as bronchiolitis obliterans organizing pneumonia) is a clinicopathological entity with characteristical radiographic findings such as bilateral, asymmetrical, sometimes migrating, patchy infiltrates in chest radiograph and ground-glass opacities in computed tomography. The disease has been observed in the context of gastrointestinal disorders, certain lung infections, autoimmune-mediated diseases (such as Wegener granulomatosis), inhalation of toxic fumes, bone marrow transplantation and administration of drugs. The benzofuran amiodarone, a commonly used antiarrythmic drug for atrial fibrillation, can exhibit several pulmonary adverse effects, amongst them cryptogenic organizing pneumonia as a rarely diagnosed and published one. We report a case of cryptogenic organizing pneumonia secondary to amiodarone treatment, its clinical course with significant improvement of clinical symptoms within a few days after discontinuation of amiodarone treatment and administration of corticosteroids. Also the infiltrations found in chest X-ray and computed tomography responded well and showed remarkable resolution tendency quickly. During 5 months of corticoid therapy pulmonary abnormalities gradually resolved almost completely and remained equal during the 8 months follow-up after corticoid termination.
References
Epler GR (2001) Bronchiolitis organizing pneumonia. Arch Intern Med 161(2): 158–64
Epler GR (2004) Drug-induced bronchiolitis obliterans organizing pneumonia. Clin Chest Med 25(1): 89–94
King TE Jr (1995) BOOP: an important cause of migratory pulmonary infiltrates? Eur Respir J 8(2): 193–5
Oymak FS, Demirbaş HM, Mavili E, Akgun H, Gulmez I, Demir R, Ozesmi M (2005) Bronchiolitis obliterans organizing pneumonia. Clinical and roentgenological features in 26 cases. Respiration 72(3): 254–62
Cordier JF (2006) Cryptogenic organising pneumonia. Eur Respir J 28(2): 422–46
Crestani B, Taillé C, Borie R, Debray MP, Danel C, Dombret MC, Aubier M (2009) Organizing pneumonia. Presse Med [Epub ahead of print]
Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN (2008) Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review. Ann Thorac Med 3(2): 67–75
Crestani B, Valeyre D, Roden S, Wallaert B, Dalphin JC, Cordier JF (1998) Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. The Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires (GERM"O"P). Am J Respir Crit Care Med 158(6): 1929–35
Afessa B, Litzow MR, Tefferi A (2001) Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation. Bone Marrow Transplant 28(5): 425–34
Garrido M, O'Brien A, González S, Clavero JM, Orellana E (2007) Cryptogenic organizing pneumonitis during oxaliplatin chemotherapy for colorectal cancer: case report. Chest 132(6): 1997–9
Biehn SE, Kirk D, Rivera MP, Martinez AE, Khandani AH, Orlowski RZ (2006) Bronchiolitis obliterans with organizing pneumonia after rituximab therapy for non-Hodgkin's lymphoma. Hematol Oncol 24(4): 234–7
Camus P, Fanton A, Bonniaud P, Camus C, Foucher P (2004) Interstitial lung disease induced by drugs and radiation. Respiration 71(4): 301–26
Mueller M, Schima W, Weissel M (1997) Spontanremission einer Amiodaron-assoziierten Lungenparenchymschädigung. Wien Klin Wochenschr 109(22): 887–9
Valle JM, Alvarez D, Antúnez J, Valdés L (1995) Bronchiolitis obliterans organizing pneumonia secondary to amiodarone: a rare aetiology. Eur Respir J 8(3): 470–1
Sarin S, Hussain A, Prichard J, McKillion P (2006) Manifestations of lung toxicity: amiodarone-induced bronchiolitis obliterans organizing pneumonia. Resid Staff Physician 52(6): 16–22
Camus P, Lombard JN, Perrichon M, Piard F, Guérin JC, Thivolet FB, Jeannin L (1989) Bronchiolitis obliterans organising pneumonia in patients taking acebutolol or amiodarone. Thorax 44(9): 711–5
Martin WJ, Rosenow EC (1988) Amiodarone pulmonary toxicity. Recognit Pathog Chest 93(5): 1067–75
Yamada Y, Shiga T, Matsuda N, Hagiwara N, Kasanuki H (2007) Incidence and predictors of pulmonary toxicity in Japanese patients receiving low-dose amiodarone. Circ J 71(10): 1610–6
Burns KE, Piliotis E, Garcia BM, Ferguson KA (2000) Amiodarone pulmonary, neuromuscular and ophthalmological toxicity. Can Respir J 7(2): 193–7
Jarand J, Lee A, Leigh R (2007) Amiodaronoma: an unusual form of amiodarone-induced pulmonary toxicity. CMAJ 176(10): 1411–3
Camus P, Martin WJ, Rosenow EC (2004) Amiodarone pulmonary toxicity. Clin Chest Med 25(1): 65–75
Selleslagh P, De Wever W, Verbeken E, Verleden GM (2008) A patient with relapsing pneumonia. Respir Med CME 1(3): 250–2
Sunderji R, Kanji Z, Gin K (2000) Pulmonary effects of low dose amiodarone: a review of the risks and recommendations for surveillance. Can J Cardiol 16(11): 1435–40
Costabel U, Guzman J, Teschler H (1995) Bronchiolitis obliterans with organising pneumonia: outcome. Thorax 50(1): 59–64
Kuhlman JE, Teigen C, Ren H, Hruban RH, Hutchins GM, Fishman EK (1990) Amiodarone pulmonary toxicity: CT findings in symptomatic patients. Radiology 177(1): 121–5
Oyama N, Oyama N, Yokoshiki H, Kamishima T, Nambu T, Tsutsui H, Miyasaka K (2005) Detection of amiodarone-induced pulmonary toxicity in supine and prone positions: high-resolution computed tomography study. Circ J 69(4): 466–70
Ohar JA, Jackson F, Dettenmeier PA, Bedrossian CW, Tricomi SM, Evans RG (1992) Bronchoalveolar lavage cell count and differential are not reliable indicators of amiodarone-induced pneumonitis. Chest 102(4): 999–1004
Ott MC, Khoor A, Leventhal JP, Paterick TE, Burger CD (2003) Pulmonary toxicity in patients receiving low-dose amiodarone. Chest 123(2): 646–51
Omeroglu G, Kalugina Y, Ersahin C, Wojcik EM (2006) Amiodarone lung toxicity in a cardiac transplant candidate initially diagnosed by fine-needle aspiration: cytologic, histologic, and electronmicroscopic findings. Diagn Cytopathol 34(5): 351–4
Greenspon AJ, Kidwell GA, Hurley W, Mannion J (1991) Amiodarone-related postoperative adult respiratory distress syndrome. Circulation 84(5): 407–15
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schindler, K., Schima, W. & Kaliman, J. Cryptogenic organizing pneumonia due to amiodarone: long-term follow-up after corticosteroid treatment. Wien Klin Wochenschr 122, 511–514 (2010). https://doi.org/10.1007/s00508-010-1412-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00508-010-1412-3