CHEST Guidelines-Diffuse Alveolar Damage in a Patient Receiving Dro...

Diffuse Alveolar Damage in a Patient Receiving Dro...

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The article discusses a case of diffuse alveolar damage in a 68-year-old woman receiving dronedarone, an antiarrhythmic agent similar to amiodarone but reportedly with reduced toxicity due to a methyl sulfonyl group. While animal studies indicated potential lung injury with dronedarone, human trials have not established this connection until this case. The patient developed a progressive dry cough and respiratory distress five months into dronedarone therapy, along with other pre-existing conditions. Her condition worsened to hypoxemic respiratory failure, and CT scans showed diffuse lung damage with a reticular pattern. Steroid treatment post-drug discontinuation led to dramatic symptom improvement.<br /><br />Dronedarone was developed to maintain the effectiveness of amiodarone while reducing organ toxicity. However, this case indicates dronedarone can cause interstitial lung disease, a risk believed previously reduced by its structural modification. Prior human trials (DIONYSOS and ATHENA) reported no significant pulmonary-related events, although follow-ups were limited in duration and participants.<br /><br />Previous cases of dronedarone-induced lung toxicity exist, but they involved patients with prior amiodarone exposure, unlike this unique case. Laboratory tests ruled out other causes like connective tissue diseases, strengthening the link to dronedarone. The authors recommend routine monitoring of lung function in patients receiving dronedarone and prompt drug discontinuation upon pulmonary decline. This case contributes to evidence associating dronedarone with potential lung toxicity, necessitating closer observation of patients for early symptom detection and management.

Keywords

diffuse alveolar damage

dronedarone

antiarrhythmic agent

lung toxicity

interstitial lung disease

hypoxemic respiratory failure

steroid treatment

amiodarone

CT scans

pulmonary monitoring