An unusual case of asymptomatic diffuse alveolar hemorrhage related to amiodarone induced INR elevation

Abstract

Pulmonary adverse effects of amiodarone are an important cause of morbidi-ty. Such effects may rarely manifest as diffuse alveolar hemorrhage. Another important amiodarone-induced adverse effect is hepatotoxicity. Hepatotoxicity mostly presents as asymptomatic elevation of liver enzymes. To the best of our knowledge, in amiodarone-induced hepatotoxicity, AST and ALT elevation is well known; however, there are no clear data regarding high International Nor-malized Ratio (INR) levels in such a condition. In the present report, we describe the case of a patient under management with chronic low-dose amiodarone, who was admitted to the emergency department for lingual hematoma. During the assessment for bleeding diathesis, the INR was found to be 8.59. After exclud-ing all other possible causes for the high INR level, amiodarone was suggested to be the cause. Since there were diffuse infiltrations on chest x-ray, the patient underwent thorax tomography. Asymptomatic diffuse alveolar hemorrhage sec-ondary to INR elevation was considered. This patient is the first case who had amiodarone-induced INR elevation, and as a consequence, developed asymp-tomatic diffuse alveolar hemorrhage.