Nodular Amiodarone Lung Disease

被引:10
作者
Ruangchira-Urai, Ruchira [1 ,3 ,4 ]
Colby, Thomas V. [2 ]
Klein, Julianne [5 ]
Nielsen, G. Petur [1 ,3 ]
Kradin, Richard L. [1 ,3 ]
Mark, Eugene J. [1 ,3 ]
机构
[1] Massachusetts Gen Hosp, Dept Pathol, Boston, MA 02114 USA
[2] Mayo Clin, Dept Pathol, Scottsdale, AZ USA
[3] Harvard Univ, Sch Med, Boston, MA USA
[4] Siriraj Hosp Mahidol Univ, Dept Pathol, Bangkok, Thailand
[5] St Boniface Gen Hosp, Dept Pathol, Winnipeg, MB R2H 2A6, Canada
关键词
amiodarone; drug pneumonitis;
D O I
10.1097/PAS.0b013e31816d1cbc
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
The antiarrhythmic drug amiodarone accumulates in many organs of the body. Amiodarone lung disease (ALD) most commonly manifests clinically as all interstitial pneumonitis. The few reports of nodular ALD generally have been in the clinical and radiographic literature. No detailed histopathologic analysis of nodular ALD is available. We report 4 patients with nodular ALD. all of whom had excision of a nodule and none had a preoperative diagnosis of ALD. The radiographic suspicion before excisional biopsy in all 4 cases was malignancy. The initial pathologic suspicion in all 4 cases was either an abscess or vasculitis. In 3 of the 4 cases, where the dosages were known, each patient received 800mg/d for 7 or more months. All cases have strikingly similar histopathology, with vacuolated histiocytes massed within alveoli to form macroscopic modules with tissue breakdown. Ultrastructural examination Of lung and peripheral nerve in I case showed the characteristic inclusions of amiodarone in the cytoplasm of swollen histiocytes. Vacuolated histiocytes filled with these inclusions indicate the effect of the drug, but in these 4 cases there was tissue destruction, which indicated disease. The necrotizing nature of the massed histiocyles in the absence or infection or obstruction suggests the correct etiologic diagnosis even when the history of administration of the drug is not available at initial review.
引用
收藏
页码:1654 / 1660
页数:7
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