Amiodarone-induced organizing pneumonia mimicking COVID-19: a case report.
Eur J Med Res
; 26(1): 62, 2021 Jun 27.
Article
in English
| MEDLINE | ID: covidwho-1285187
ABSTRACT
BACKGROUND:
Differential diagnosis of interstitial lung diseases (ILDs) during the COVID-19 pandemic is difficult, due to similarities in clinical and radiological presentation between COVID-19 and other ILDs on the one hand, and frequent false-negative swab results on the other. We describe a rare form of interstitial and organizing pneumonia resembling COVID-19, emphasizing some key aspects to focus on to get the right diagnosis and treat the patient properly. CASE PRESENTATION A 76-year-old man presented with short breath and dry cough in the midst of the COVID-19 outbreak. He showed bilateral crackles and interstitial-alveolar opacities on X-ray, corresponding on computed tomography (CT) to extensive consolidations with air bronchograms, surrounded by ground glass opacities (GGO). Although his throat-and-nasopharyngeal swab tested negative, the picture was overall compatible with COVID-19. On the other hand, he showed subacute, rather than hyperacute, clinical onset; few and stable parenchymal consolidations, rather than patchy and rapidly evolving GGO; pleural and pericardial thickening, pleural effusion, and lymph node enlargement, usually absent in COVID-19; and peripheral eosinophilia, rather than lymphopenia, suggestive of hypersensitivity. In the past year, he had been taking amiodarone for a history of ventricular ectopic beats. CT scans, in fact, highlighted hyperattenuation areas suggestive of amiodarone pulmonary accumulation and toxicity. Bronchoalveolar lavage fluid (BALF) investigation confirmed the absence of coronavirus genome in the lower respiratory tract; conversely, high numbers of foamy macrophages, eosinophils, and cytotoxic T lymphocytes with low CD4/CD8 T-cell ratio were detected, confirming the hypothesis of amiodarone-induced cryptogenic organizing pneumonia. Timely discontinuation of amiodarone and initiation of steroid therapy led to resolution of respiratory symptoms, systemic inflammation, and radiographic opacities.CONCLUSIONS:
A comprehensive analysis of medical and pharmacological history, clinical onset, radiologic details, and peripheral and BALF cellularity, is required for a correct differential diagnosis and management of ILDs in the COVID-19 era.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Cryptogenic Organizing Pneumonia
/
Ventricular Premature Complexes
/
Withholding Treatment
/
COVID-19
/
Amiodarone
Type of study:
Case report
/
Diagnostic study
/
Observational study
/
Prognostic study
Limits:
Aged
/
Humans
/
Male
Language:
English
Journal:
Eur J Med Res
Journal subject:
Medicine
Year:
2021
Document Type:
Article
Affiliation country:
S40001-021-00522-w
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