SESSION TITLE: Diffuse Lung Disease Student/Resident Case Report Posters
SESSION TYPE: Student/Resident Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Dronedarone was approved by the FDA in 2009 for use in atrial fibrillation or atrial flutter (1). It is an analog of amiodarone, similar in structure and mode of action but lacks the iodine moiety. It has been hypothesized that due to this, dronedarone will have fewer thyroid and pulmonary side effects than amiodarone. We present a case of dronaderone induced pulmonary toxicity that was reversible after discontinuing the drug.
CASE PRESENTATION: Our case is of an 82 year old gentleman with a history of hypertension, ischemic stroke and OSA. He was started on dronedarone in 2011 after successful cardioversion of atrial fibrillation. After 3 years of use he developed worsening dyspnea and decreased exercise tolerance. His physical exam was unremarkable except for hypoxia requiring 2L O2 at rest and 4L O2 with activity. CT Chest revealed diffuse bilateral interstitial opacities. PFTs showed moderate restriction and a moderate decrease in diffusion capacity (TLC: 66%, FVC: 64%, DLCO: 48%). A detailed review of the patient’s history was unremarkable except for the use of dronedarone. PFTs done 4 months after holding dronedarone showed improvement in PFTs (TLC: 82%, FVC: 93%, DLCO: 62%). He improved symptomatically and no longer required oxygen at this point.
DISCUSSION: Dronedarone has been postulated to have less systemic side effects than amiodarone. Short-term toxicities appear to be less common among patients taking dronedarone (2) but long term studies to confirm this are lacking. A recent abstract showed that the incidence of dronedarone induced pulmonary toxicity may be more frequent than initially expected (3). Our case is one of only a few to document dronedarone-induced pulmonary toxicity and the only case report to our knowledge to document improvement in PFTs and oxygen requirements simply with removal of drug exposure.
CONCLUSIONS: In conclusion, dronedarone-induced pulmonary toxicity may be more common than previously thought. The removal of drug exposure may help reverse the effects as supported by this patient's improvement in PFTs and oxygenation.
Reference #1: Dronedarone for Atrial Fibrillation — An Odyssey Peter J. Zimetbaum, M.D.N Engl J Med 2009; 360:1811-1813April 30, 2009DOI: 10.1056/NEJMp0902248
Reference #2: Le Heuzey JY, De Ferrari GM, Radzik D, et al. A short-term, randomized, double-blind, parallel-group study to evaluate the efficacy and safety of dronedarone versus amiodarone in patients with persistent atrial fibrillation: the DIONYSOS study. J Cardiovasc Electrophysiol 2010; 21:597.
Reference #3: Incidence Of Pulmonary Toxicity After Initiation Of Dronedarone: A Cross-Sectional Study Joseph E. Khabbaza, , Seth R. Bauer, Anita J. Reddy A41. INTERSTITIAL LUNG DISEASE: RISK FACTORS AND OUTCOMES, 2014: A1506, 10.1164/ajrccm-conference.2014.189.1_MeetingAbstracts.A1506
DISCLOSURE: The following authors have nothing to disclose: Syed Abdullah Waheed, Shruti Patel
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