One week after amiodarone, we could see a peri-hilar and peri-bronchial picture like severe interstitial pneumonia without adequate reaction of inflammation parameters in a burn patient. Has anyone seen anything like this? Perhaps any literature suggestions?
Amiodarone induced pulmonary infiltrates are an exclusion diagnosis.
Even the suggestive picture on induced sputum ( as described by us) does not necessarily prove toxicity . Chest imaging may show different appearances, including interstital lung disease but also more solid patchy infiltrates.
The cumulative dose may have an impact but oftentimes it is an idiosyncratic event.
I would consider a Bronchoalveolar lavage - mainly to exclude infectious etiologies , especially if there is no suitable alternative for anti-arrhythmic therapy .
I work in a burn center but I have never seen pneumonia after amiodarone.
Thanks to all of you who contributed answers. The really impressive picture resolved after one week of amiodarone withdrawal. All the other tests were negative!