Pulmonary Toxicity of Amiodarone

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Abstract
To the Editor. —The Editorial by Estes1on the role of amiodarone for the management of atrial fibrillation describes several amiodarone dose-related adverse effects. However, we were surprised that there was no mention of pulmonary toxic effects, which are the most serious side effects, and which have an incidence estimated from 0.5% to 10% and a mortality of 1% to 33%.2Although an immunologic mechanism may contribute (as shown by improvement with corticosteroids and elevation of CD8 lymphocytes in bronchoalveolar lavage), some findings argue for a toxic dose-dependent mechanism.3 Unfortunately, routine pulmonary function tests have not been useful to predict pulmonary side effects of amiodarone.4These effects have most frequently included diffuse interstitial pneumonitis, but cases presenting with segmental pulmonary consolidation, fatal respiratory distress syndrome, pulmonary fibrosis, and pleural effussion have also been described. These kinds of clinical presentation might lead to a wrong diagnosis of

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