Reactions 1451 - 11 May 2013

SIopromide

Eosinophilic pneumonia and pulmonary fibrosis:case report

A 51-year-old man developed eosinophilic pneumonia andpulmonary fibrosis following administration of the contrastmedium iopromide [dosage and time to reaction onset notstated].

The man’s medical history included hypothyroidism,hypertension and heart failure. During coronary angiography,he received 60mL of IV iopromide. Shortly thereafter, hedeveloped tachycardia, tachypnoea, dyspnoea and hypoxia. Achest x-ray revealed bilateral reticular thickening.

The man received prednisolone, and his conditionimproved. However, his x-ray findings remained abnormalover the following 15 days, with pO2, pCO2 and FiO2 of47–49mm Hg, 37–39mm Hg and 21%, respectively. His abilityfor exercise was reduced, and body plethysmography wascompatible with a restrictive disorder and severe diffusiondisorder. The transfer factor of the lung for carbon monoxidewas 34%, and the rate of carbon monoxide uptake was 61%.He had a total lung capacity of 3.81 (55%), FEV1 of 1.8L (51%)and a vital capacity of 2.21 (49%). Lung CT showed aneosinophilic pulmonary fibrosis pattern of air-space diseaseand patchy peripheral ground-glass opacities. A biopsyrevealed severe fibrosis throughout most of the lung. chronicinterstitial pneumonitis with eosinophils and fibrosis wasmade. He was treated with a gradually reducing dose ofcorticosteroids. One year later, his condition had improved.

Author comment: "[I]t is clear that this acute andextremely rapidly progressive pulmonary disorder was drug-associated. . . [T]he procedure took place immediately afterthe dispensation of iodinated contrast medium. This last factcould possibly have been the cause that triggered theimmunologic mechanisms and set in motion multiplereactions, resulting eventually in the destruction of the lung."Schmidt W-H, et al. Chronic eosinophilic pneumonia due to radiographic contrastadministration: An orphan disease?. Drug Design, Development and Therapy 6:385-389, 6 Dec 2012. Available from: URL: http://dx.doi.org/10.2147/DDDT.S37937 - Germany 803086635

1

Reactions 11 May 2013 No. 14510114-9954/10/1451-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved