48-year-old woman with dyspnea cough and weight loss
Her medications included furosemide, losartan, digoxin, coumadin, amiodarone, and spironolactone. After few hours from intubation we were forced to institute a veno-venous extracorporeal membrane oxygenation due to the worsening of pulmonary function. Unfortunately amiodarone-induced pulmonary toxicity is described for medium-long term therapy. A 48-year-old woman presented to our emergency department with progressive dyspnea, cough with clear sputum, and a 9-kg weight loss. Due to the deterioration of the clinical picture, we proceeded to intubation. Despite diuretic therapy, along with aspirin, statins and antibiotics the patient continued to complain of severe dyspnea and had a moderate fever. Pulmonary examination revealed crackles over the right middle lobe but otherwise normal results. No new medications had been added to her treatment regimen during the past 10 years. Chest radiography showed bilateral dense consolidations that were greater on the right with clear costophrenic angles, an AICD, and cardiomegaly. Thus, diagnostic hypotheses different from acute cardiac failure were considered, in particular non-cardiogenic causes of pulmonary infiltrates.
Her symptoms continued, and 1 month later, she went to an outside pulmonologist who found bilateral alveolar infiltrates on chest computed tomography (CT). Following suspicion of amiodarone-induced pulmonary toxicity, the drug was discontinued and corticosteroid therapy was initiated. Her medical history was notable for nonischemic dilated cardiomyopathy that was treated with cardiac resynchronization therapy and an automatic implantable cardioverter-defibrillator (AICD), atrial fibrillation, and myelodysplastic syndrome. She had a 10-pack-year smoking history but had quit smoking 1 year previously. For full functionality of ResearchGate it is necessary to enable JavaScript. Abdominal, musculoskeletal, and neurologic examination findings were unremarkable. This is a temporary store for items of interest to you. Indications for use of ECMO have expanded considerably. Burger b, a Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Jacksonville, FL b Advisor to Residents and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL Correspondence: Address to Charles D. Evaluation at an outside emergency department 6 months previously had revealed a right middle lobe infiltrate on chest radiography (CXR), and she was treated with a 10-day course of levofloxacin for presumed community-acquired pneumonia. On presentation to our emergency department, the patient reported no orthopnea, fevers, chills, or night sweats.
48-year-old woman with dyspnea cough and weight loss video:
