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Amiodarone pulmonary toxicity — SCE Respiratory MCQ

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ModerateILDAmiodarone pulmonary toxicitySCE Respiratory

A 68-year-old man develops worsening dyspnoea and non-productive cough 7 months after starting amiodarone for atrial fibrillation. HRCT shows bilateral high-attenuation consolidation and ground-glass change; TLCO has fallen from 76% to 45% predicted. Infection screen is negative. What is the most likely underlying cause?

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Correct answer: C — Amiodarone-induced pulmonary toxicity

The timing after amiodarone initiation, falling TLCO and high-attenuation parenchymal opacities are characteristic of amiodarone lung toxicity. Nitrofurantoin, methotrexate and radiation pneumonitis need the corresponding drug or radiation exposure, which is absent. Organising pneumonia can mimic this radiologically but the exposure history makes drug toxicity the best answer.

Reference: BNF; BTS ILD guidance