PT - JOURNAL ARTICLE AU - Brandon T. Larsen AU - Laszlo T. Vaszar AU - Henry D. Tazelaar AU - Thomas V. Colby TI - Lymphoid hyperplasia and eosinophilic pneumonia as histologic manifestations of amiodarone-induced lung toxicity DP - 2011 Sep 01 TA - European Respiratory Journal PG - p3742 VI - 38 IP - Suppl 55 4099 - http://erj.ersjournals.com/content/38/Suppl_55/p3742.short 4100 - http://erj.ersjournals.com/content/38/Suppl_55/p3742.full SO - Eur Respir J2011 Sep 01; 38 AB - Background: Amiodarone use is often limited by lung toxicity. Amiodarone lung disease (ALD) classically manifests as organizing pneumonia with intra-alveolar foamy macrophages, but other patterns may occur. Herein we report two previously unreported patterns of ALD, lymphoid hyperplasia (LH) and eosinophilic pneumonia (EP).Method: We identified patients with LH or EP as a prominent feature among 75 cases of probable ALD from the authors' teaching files collected from 1997-2010. Clinical history and wedge biopsies were reviewed.Results: Twelve patients (7 men) met inclusion criteria. Median age was 71 years. Amiodarone dose was known in 10 cases (median 200mg/d). Treatment duration was known in 8 cases and ranged from 1 to 9 years. Thoracic imaging showed diffuse infiltrates concerning for ALD. Histologic review revealed intra-alveolar foamy macrophages in all cases. Eight cases prominently displayed patterns of LH including diffuse LH (7), follicular bronchiolitis (5), lymphocytic interstitial pneumonia (2), and lymphocytic perivascular cuffing (2). Two showed features of acute EP including diffuse alveolar damage with abundant eosinophils. Two showed features of chronic EP including interstitial pneumonia with abundant eosinophils, patchy organization, fibrinous exudates, and interstitial thickening. One chronic EP case also showed focal LH. Additional features included intra-alveolar giant cells (6), pleuritis (3), small poorly-formed granulomas (3), and thrombi (2).Conclusions: Lymphoid hyperplasia and eosinophilic pneumonia are previously unrecognized histopathologic manifestations of ALD, and amiodarone exposure should be included in their differential diagnosis.