Pulmonary masses in a patient with blue-gray cutaneous hyperpigmentation

Area of Science:

• Pulmonology
• Dermatology
• Pharmacology

Background:

• Amiodarone is a widely used antiarrhythmic drug.
• Drug-induced lung injury and skin pigmentation are known side effects of amiodarone.
• Blue-gray syndrome is a rare manifestation of amiodarone toxicity.

Observation:

• A patient on amiodarone therapy developed progressive dyspnea, cough, fever, and extensive skin pigmentation.
• Pulmonary masses with high attenuation on nonenhanced chest CT were observed.
• Bronchoalveolar lavage revealed numerous foamy macrophages.

Findings:

• The clinical presentation and diagnostic findings were consistent with amiodarone-induced pulmonary toxicity and blue-gray syndrome.
• Discontinuation of amiodarone therapy resulted in significant improvement of respiratory symptoms.
• Radiological evidence of pulmonary masses also showed improvement after drug withdrawal.

Implications:

• This case highlights the importance of considering amiodarone toxicity in patients presenting with unexplained pulmonary masses and skin pigmentation.
• Early diagnosis and prompt discontinuation of amiodarone are crucial for managing this adverse effect.
• Awareness of blue-gray syndrome and amiodarone lung toxicity is essential for clinicians managing patients on this medication.