Introduction: Pulmonary complications related to amiodarone have become exceptional with the doses currently used; their
frequency is estimated at 1.6-2%. Acute or subacute pneumonia is the most classic manifestation. Pleural involvement under
amiodarone is exceptional and unusual. We report an original observation of triple toxicity to amiodarone with concomitant
pulmonary parenchymal, pleural and hepatic involvement and which was spontaneously resolved.
Case Report: 71-years-old patient, hypertensive and diabetic type 2, without degenerative complications, treated with
amiodarone for four years for atrial fibrillation, was hospitalized because of severe acute pneumopathy evolving for ten days. Biology
revealed moderate cytolytic hepatitis (ASAT at 130 IU/l and ALAT at 243 IU/l) without cholestasis or liver failure. Chest X-ray and
thoracic CT showed bilateral and diffuse interstitial infiltrates, severe bilateral pneumonitis of both upper lobes, diffuse patchy
infiltrates and ground–glass opacity, and bilateral pleural effusion. Abdominal ultrasound and CT showed moderate homogeneous
and hyperdense hepatomegaly without focal lesions. The infectious, immunological, and tumoral investigations were negative. The
hypothesis of drug toxicity was retained, and the evolution was rapidly favorable after stopping amiodarone with disappearance of
respiratory complaints, normalization of liver tests, and progressive radiological cleansing. Chest radiography and thoracic CT scan
were substantially normal at six months.
Conclusion: Amiodarone-induced complex pulmonary toxicity with parenchymal and pleural involvement remains exceptional
and not well known by clinicians. Regular clinical and radiological monitoring are recommended to detect and manage them in time,
and improve the prognosis given the risk of irreversible fibrosis evaluated at 5-7% of cases.
