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Amiodarone Pulmonary Toxicity — EECC MCQ

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ModerateCardiac PharmacologyAmiodarone Pulmonary ToxicityEECC

A 62-year-old woman on long-term amiodarone develops progressive breathlessness and dry cough. Chest X-ray shows bilateral interstitial infiltrates. DLCO is reduced. What is the likely diagnosis?

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Correct answer: D — Amiodarone-induced pulmonary toxicity — a serious adverse effect occurring in 5-10% of patients on long-term amiodarone, potentially fatal if not recognised early

Amiodarone pulmonary toxicity (APT) is a serious complication occurring in approximately 5-10% of patients on long-term therapy, even at low doses (100-200 mg daily). Mechanisms include: direct cytotoxicity (phospholipidosis) and indirect immune-mediated injury. Presentation ranges from subacute (insidious breathlessness, cough, fever) to acute (ARDS). Diagnosis: bilateral interstitial or alveolar infiltrates on CXR/CT (often with high-density areas reflecting iodine content), reduced DLCO, and exclusion of other causes. Management: stop amiodarone immediately (long half-life 40-55 days means effects persist); corticosteroids (prednisolone 40-60 mg) for significant disease; outcomes depend on early recognition. Baseline and annual PFTs with DLCO are recommended for all patients on amiodarone.

Reference: BNF; ESC (2024): AF Guidelines