Drugs are well known causes of eosinophilic
lung disease. In many
patients,
drug-induced eosinophilic
lung disease presents with
transient eosinophilic infiltrates that disappear after discontinuation of the
drug. Some
patients, however, experience a fulminant, acute
eosinophilia-like
disease. Recently, we experienced a case of
amitriptyline-associated acute
eosinophilic pneumonia with
respiratory failure in a diabetic
hemodialysis patient. Eight days
after treatment with
amitriptyline, sudden
fever, chill, dry
cough and
dyspnea developed. Subsequently, multiple patch consolidations appeared on the
chest radiographs.
Bronchoalveolar lavage (BAL), established a
diagnosis of acute
eosinophilic pneumonia. After immediate discontinuation of
amitriptyline, a rapid clinical and radiological improvement was observed. The present case indicates that the possibility of acute
eosinophilic pneumonia should be fully considered in
dialysis patients developing unexplained respiratory symptoms while on
amitriptyline therapy.