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Successful Treatment of Severe Amiodarone Pulmonary Toxicity With Polymyxin B-Immobilized Fiber Column Direct HemoperfusionTherapy for Amiodarone Pulmonary Toxicity

Nahoko Sato, MD; Keisuke Kojima, MD, PhD; Yuko Horio, MD; Eisuke Goto, MD, PhD; Aiko Masunaga, MD; Hidenori Ichiyasu, MD, PhD; Hirotsugu Kohrogi, MD, PhD
Author and Funding Information

From the Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.

Correspondence to: Hirotsugu Kohrogi, MD, PhD, Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan; e-mail: kohrogi@kumamoto-u.ac.jp


This case report was presented at CHEST 2011, Honolulu, HI, October 22-26, 2011.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):1146-1150. doi:10.1378/chest.12-0994
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Amiodarone pulmonary toxicity (APT) is the most serious side effect of amiodarone. Although severe APT, such as ARDS, is rare, mortality of severe APT is high. Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is a medical device that reduces blood endotoxin levels in sepsis. Recent reports have shown that PMX-DHP improves oxygenation in patients with acute exacerbation of idiopathic pulmonary fibrosis and drug-induced severe interstitial pneumonia. Here, we present a case study of a patient with severe APT treated with PMX-DHP with complete recovery. The patient rapidly developed respiratory failure and required mechanical ventilation. Despite corticosteroid pulse therapy, no clinical improvement was noted. PMX-DHP was then started, and severe respiratory failure improved with reduction of serum levels of amiodarone and its metabolite monodesethylamiodarone. The patient was weaned from mechanical ventilation and has done well without recurrence. To our knowledge, this is the first reported case of PMX-DHP therapy for severe APT. We speculate that PMX-DHP could be a new treatment strategy for severe APT.

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