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Amiodarone Pulmonary Toxicity — RACP Adult Medicine MCQ

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ModerateClinical PharmacologyAmiodarone Pulmonary ToxicityRACP Adult Medicine

A 62-year-old man on long-term amiodarone for AF develops progressive breathlessness. HRCT shows bilateral reticular opacities with ground-glass changes, predominantly in the upper lobes. His DLCO has fallen from 85% to 55% predicted over 12 months. What is the most likely diagnosis?

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Correct answer: B — Amiodarone pulmonary toxicity

Amiodarone pulmonary toxicity (APT) occurs in 2–17% of patients and can present as organising pneumonia, NSIP-pattern ILD, or (less commonly) acute lung injury. It typically causes bilateral infiltrates with ground-glass and reticular changes, often with increased lung density (due to iodine content). Falling DLCO is an early marker. Management involves cessation of amiodarone (noting its 40–55-day half-life, so toxicity may persist for months) and corticosteroid therapy (prednisolone 40–60 mg, slow taper over 6–12 months).

Reference: AMH – 2025 – Amiodarone; eTG – 2025 – Respiratory