A case of fibrosing interstitial pneumonia

We report here the case of a 70 year-old male, lifelong never smoker, who has been admitted to our inpatient Pulmonology clinic for the presence by one month of persistent fever associated in the last seven days with fatigue and mild exertional dyspnea (2 at the Borg scale). An arterial blood gas analysis performed during oxygen therapy [fractional concentration of oxygen in inspired gas (FiO2) of 40%] showed the presence of an acute hypoxemic respiratory failure. He had a past medical history of paroxysmal atrial fibrillation treated in the last two years with low-dose amiodarone and edoxaban. High-resolution computed tomography of the chest showed a bilateral, but with the prevalence in the right lung, pattern of interstitial lung disease with diffuse ground glass opacities with high attenuation, interstitial thickening, traction bronchiectasis and honeycombing. A diagnosis of amiodarone-induced pulmonary fibrosis was done and the drug was stopped and replaced with bisoprolol and concomitant treatment with systemic glucocorticoids for two weeks was started. The patient was discharged at home without respiratory failure. The patient died five months later in the Pulmonology clinic “Vittorio Emanuele” University Hospital of Catania, Italy during another acute exacerbation of its disease. Our report is a reminder for clinicians to recognize that even low-dose amiodarone (200 mg/daily) may be associated with severe pulmonary fibrosis. There is a complete absence of a standardized approach to the diagnosis and treatment of this disease.