Amiodarone-induced organizing pneumonia mimicking COVID-19: a case report
Abstract Background Differential diagnosis of interstitial lung diseases (ILDs) during the COVID-19 pandemic is difficult, due to similarities in clinical and radiological presentation between COVID-19 and other ILDs on the one hand, and frequent false-negative swab results on the other. We describe...
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| Format: | Article |
| Language: | English |
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BMC
2021-06-01
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| Series: | European Journal of Medical Research |
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| Online Access: | https://doi.org/10.1186/s40001-021-00522-w |
| _version_ | 1819121848729731072 |
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| author | Gaetano Zizzo Stefano Caruso Elisabetta Ricchiuti Roberto Turato Ilario Stefani Antonino Mazzone |
| author_facet | Gaetano Zizzo Stefano Caruso Elisabetta Ricchiuti Roberto Turato Ilario Stefani Antonino Mazzone |
| author_sort | Gaetano Zizzo |
| collection | DOAJ |
| description | Abstract Background Differential diagnosis of interstitial lung diseases (ILDs) during the COVID-19 pandemic is difficult, due to similarities in clinical and radiological presentation between COVID-19 and other ILDs on the one hand, and frequent false-negative swab results on the other. We describe a rare form of interstitial and organizing pneumonia resembling COVID-19, emphasizing some key aspects to focus on to get the right diagnosis and treat the patient properly. Case presentation A 76-year-old man presented with short breath and dry cough in the midst of the COVID-19 outbreak. He showed bilateral crackles and interstitial-alveolar opacities on X-ray, corresponding on computed tomography (CT) to extensive consolidations with air bronchograms, surrounded by ground glass opacities (GGO). Although his throat-and-nasopharyngeal swab tested negative, the picture was overall compatible with COVID-19. On the other hand, he showed subacute, rather than hyperacute, clinical onset; few and stable parenchymal consolidations, rather than patchy and rapidly evolving GGO; pleural and pericardial thickening, pleural effusion, and lymph node enlargement, usually absent in COVID-19; and peripheral eosinophilia, rather than lymphopenia, suggestive of hypersensitivity. In the past year, he had been taking amiodarone for a history of ventricular ectopic beats. CT scans, in fact, highlighted hyperattenuation areas suggestive of amiodarone pulmonary accumulation and toxicity. Bronchoalveolar lavage fluid (BALF) investigation confirmed the absence of coronavirus genome in the lower respiratory tract; conversely, high numbers of foamy macrophages, eosinophils, and cytotoxic T lymphocytes with low CD4/CD8 T-cell ratio were detected, confirming the hypothesis of amiodarone-induced cryptogenic organizing pneumonia. Timely discontinuation of amiodarone and initiation of steroid therapy led to resolution of respiratory symptoms, systemic inflammation, and radiographic opacities. Conclusions A comprehensive analysis of medical and pharmacological history, clinical onset, radiologic details, and peripheral and BALF cellularity, is required for a correct differential diagnosis and management of ILDs in the COVID-19 era. |
| first_indexed | 2024-12-22T06:43:05Z |
| format | Article |
| id | doaj.art-d466c0b8e1594922a4f5eae66aba42d1 |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-12-22T06:43:05Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-d466c0b8e1594922a4f5eae66aba42d12022-12-21T18:35:23ZengBMCEuropean Journal of Medical Research2047-783X2021-06-012611810.1186/s40001-021-00522-wAmiodarone-induced organizing pneumonia mimicking COVID-19: a case reportGaetano Zizzo0Stefano Caruso1Elisabetta Ricchiuti2Roberto Turato3Ilario Stefani4Antonino Mazzone5Department of Internal Medicine, Legnano and Cuggiono Hospitals, ASST Ovest MilaneseUnit of Endoscopy, Cuggiono Hospital, ASST Ovest MilaneseDepartment of Internal Medicine, Legnano and Cuggiono Hospitals, ASST Ovest MilaneseDivision of Cardiorespiratory Medicine, Cuggiono Hospital, ASST Ovest MilaneseDepartment of Internal Medicine, Legnano and Cuggiono Hospitals, ASST Ovest MilaneseDepartment of Internal Medicine, Legnano and Cuggiono Hospitals, ASST Ovest MilaneseAbstract Background Differential diagnosis of interstitial lung diseases (ILDs) during the COVID-19 pandemic is difficult, due to similarities in clinical and radiological presentation between COVID-19 and other ILDs on the one hand, and frequent false-negative swab results on the other. We describe a rare form of interstitial and organizing pneumonia resembling COVID-19, emphasizing some key aspects to focus on to get the right diagnosis and treat the patient properly. Case presentation A 76-year-old man presented with short breath and dry cough in the midst of the COVID-19 outbreak. He showed bilateral crackles and interstitial-alveolar opacities on X-ray, corresponding on computed tomography (CT) to extensive consolidations with air bronchograms, surrounded by ground glass opacities (GGO). Although his throat-and-nasopharyngeal swab tested negative, the picture was overall compatible with COVID-19. On the other hand, he showed subacute, rather than hyperacute, clinical onset; few and stable parenchymal consolidations, rather than patchy and rapidly evolving GGO; pleural and pericardial thickening, pleural effusion, and lymph node enlargement, usually absent in COVID-19; and peripheral eosinophilia, rather than lymphopenia, suggestive of hypersensitivity. In the past year, he had been taking amiodarone for a history of ventricular ectopic beats. CT scans, in fact, highlighted hyperattenuation areas suggestive of amiodarone pulmonary accumulation and toxicity. Bronchoalveolar lavage fluid (BALF) investigation confirmed the absence of coronavirus genome in the lower respiratory tract; conversely, high numbers of foamy macrophages, eosinophils, and cytotoxic T lymphocytes with low CD4/CD8 T-cell ratio were detected, confirming the hypothesis of amiodarone-induced cryptogenic organizing pneumonia. Timely discontinuation of amiodarone and initiation of steroid therapy led to resolution of respiratory symptoms, systemic inflammation, and radiographic opacities. Conclusions A comprehensive analysis of medical and pharmacological history, clinical onset, radiologic details, and peripheral and BALF cellularity, is required for a correct differential diagnosis and management of ILDs in the COVID-19 era.https://doi.org/10.1186/s40001-021-00522-wAmiodaroneToxicityCOVID-19PneumoniaILDDiagnosis |
| spellingShingle | Gaetano Zizzo Stefano Caruso Elisabetta Ricchiuti Roberto Turato Ilario Stefani Antonino Mazzone Amiodarone-induced organizing pneumonia mimicking COVID-19: a case report European Journal of Medical Research Amiodarone Toxicity COVID-19 Pneumonia ILD Diagnosis |
| title | Amiodarone-induced organizing pneumonia mimicking COVID-19: a case report |
| title_full | Amiodarone-induced organizing pneumonia mimicking COVID-19: a case report |
| title_fullStr | Amiodarone-induced organizing pneumonia mimicking COVID-19: a case report |
| title_full_unstemmed | Amiodarone-induced organizing pneumonia mimicking COVID-19: a case report |
| title_short | Amiodarone-induced organizing pneumonia mimicking COVID-19: a case report |
| title_sort | amiodarone induced organizing pneumonia mimicking covid 19 a case report |
| topic | Amiodarone Toxicity COVID-19 Pneumonia ILD Diagnosis |
| url | https://doi.org/10.1186/s40001-021-00522-w |
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