YOSHIKAWA, MD 1 HASHIMOTO, MD,FJCC

Transcription

1 1 Interstitial Pneumonitis Followed by Syndrome of Inappropriate Antidiuretic Hormone Secretion Induced by Amiodarone Therapy for Dilated Cardiomyopathy : A Case Report 1 2 Shunji Makoto Naoaki Shunichi Tetsuo Akihiko Yuji Mitsuaki YOSHIKAWA, MD 1 SUZUKI, MD ICHIHARA, MD SATO, MD ARAKAWA, MD MATSUMURA, MD HASHIMOTO, MD,FJCC ISOBE, MD, FJCC 2 Abstract An 87-year-old man had been treated under a diagnosis of idiopathic dilated cardiomyopathy and sick sinus syndrome since His heart failure was worsened by atrial fibrillation in August He received amiodarone from October He was admitted to our hospital with shortness of breath in February Chest radiography revealed a diffuse reticular shadow in the right lung field and pleural effusion. The diagnosis was interstitial pneumonitis induced by amiodarone. However, 10 days after the discontinuation of amiodarone, the serum sodium concentration fell to 114mEq/l. The blood and urine chemical data were consistent with syndrome of inappropriate antidiuretic hormone secretion SIADH. The serum sodium concentration improved with fluid restriction. Clinicians should be aware that SIADH may occur during amiodarone therapy. J Cardiol 2006 Oct; 48 4 : Key Words Amiodarone Cardiomyopathies, dilated Hormones syndrome of inappropriate antidiuretic hormone secretion Complications interstinal pneumonitis 1 syndrome of inappropriate antidiuretic hormone secretion : SIADH : ; 1 : ; 2 Department of Cardiology, Kameda Medical Center, Chiba; 1 present Department of Cardiology, Social Insurance Central General Hospital, Tokyo; 2 Department of Cardiology, Tokyo Medical and Dental University, School of Medicine, Tokyo Address for correspondence: YOSHIKAWA S, MD, Department of Cardiology, Social Insurance Central General Hospital, Hyakunincho , Shinjuku-ku, Tokyo ; shunjiyoshikawa-circ@umin.ac.jp Manuscript received December 13, 2005; revised May 26 and June 3, 2006; accepted June 5,

2 216 1 Table 1 Laboratory data on admission Blood gas analysis ph 7.44 BUN Cr 11 mg/dl 1.0 mg/dl 87 : : : PCO2 PO2 HCO 3 BE Blood cell count 36.7 Torr 54.6 Torr 25.4 meq/l 2.4 meq/l Na K Cl GOT GPT 138 meq/l 4.3 meq/l 100 meq/l 25 U/l 18 U/l WBC /mm 3 LDH 538 U/l : : 1996 DDD 40 mg RBC /mm 3 Hb 14.6 g/dl Ht 41.1% Plt /mm 3 Blood chemistry CK Glucose CRP BNP TSH 48 U/l 91 mg/dl 1.35 mg/dl 382 pg/ml 2.2 U/ml 25mg5mg TP 6.9 g/dl Free T3 1.7 pg/ml 2.5mg Alb 3.5 g/dl KL U/ml 2.5mg mg/day 100mg/day X : 120/50 mmhg100/min 36.8 C 98% O 2 2 l/min S3 Levine fine crackle Table 1 : PO Torr WBC /mm 3 LDH 538U/l CRP 1.35 mg/dl LDH KL U/ml 183 U/ml amiodarone g/ml desethylamiodarone g/ml : T X Fig. 1 : : 54mm Fig. 1 Chest radiogram on admission showing diffuse infiltration in the right lung field 51% 31mmHg Fig. 2 : :%41% %CO 46% J Cardiol 2006 Oct; 48 4 :

3 SIADH Fig. 2 Computed tomography scan of the chest revealing diffuse reticular shadow in the right lung field and pleural effusion Fig. 3 Clinical course Na 114mEq/l Na Na Na 243 mosm/kg 580 mosm/kgna114 meq/l BUN 20 mg/dl Cr 0.9 mg/dl cortisol 30.1 g/dl Na 86 meq/l SIADH 6 SIADH 2.0 pg/ml Na 9.0 ng/dl Na amiodarone g/ml desethylamiodarone g/ml 10 SIADH SIADH Fig. 4 Chest radiogram at discharge showing marked improvement of interstitial pneumonitis SIADH meq/l Fig. 3 3 Fig

4 % mg 50 %CO 80% 4 4 NaSIADH ,000 mg mg Na SIADH SIADH 2 9 Ikegami 5 SIADH 2 SIADH 1 SIADH SIADH SIADH 10 SIADH SIADH SIADH 10 1 Na 5 Na SIADH SIADH SIADH SIADH SIADH SIADH 2 J Cardiol 2006 Oct; 48 4 :

5 SIADH mg X 10Na114 meq/l SIADH SIADH SIADH J Cardiol 2006 Oct; 48 4 : Amiodarone Trial Meta-Analysis Investigators: Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: Meta-analysis of individual data from 6500 patients in randomized trials. Lancet 1997 ; 350: Podrid PJ: Amiodarone : Reevaluation of an old drug. Ann Intern Med 1995; 122: Martin WJ, Rosenow EC : Amiodarone pulmonary toxicity : Recognition and pathogenesis Part1. Chest 1988; 93 : Dusman RE, Stanton MS, Miles WM, Klein LS, Zipes DP, Fineberg NS, Heger JJ : Clinical features of amiodaroneinduced pulmonary toxicity. Circulation 1990; 82 : Ikegami H, Shiga T, Tsushima T, Nirei T, Kasanuki H : Syndrome of inappropriate antidiuretic hormone secretion SIADH induced by amiodarone: A report of two cases. J Cardiovasc Pharmacol Ther 2002; 7 : Aslam MK, Gnaim C, Kutnick J, Kowal RC, McGuire DK : Syndrome of inappropriate antidiuretic hormone secretion SIADH induced by amiodarone therapy. Pacing Clin Elecrophysiol 2004 ; 27: Patel GP, Kasiar JB: Syndrome of inappropriate antidiuretic hormone-induced hyponatremia associated with amiodarone. Pharmacotherapy 2002; 22 : Odeh M, Schiff E, Oliven A : Hyponatremia during therapy with amiodarone. Arch Intern Med 1999 ; 159 : Robertson GL : Disorders of the neurohypophysis. in Harrison s Principles of Internal Medicine, 15th Ed. McGraw-Hill, 2001 ; pp : amiodarone 1993; 27 :