Drugs are well known causes of eosinophilic lung disease. In many patients,
drug-induced eosinophilic lung disease presents with transient eosinophili
c infiltrates that disappear after discontinuation of the drug. Some patien
ts, however, experience a fulminant, acute eosinophilia-like disease. Recen
tly, we experienced a case of amitriptyline-associated acute eosinophilic p
neumonia with respiratory failure in a diabetic hemodialysis patient. Eight
days after treatment with amitriptyline, sudden fever, chill, dry cough an
d dyspnea developed. Subsequently, multiple patch consolidations appeared o
n the chest radiographs. Bronchoalveolar lavage (BAL), established a diagno
sis of acute eosinophilic pneumonia. After immediate discontinuation of ami
triptyline, a rapid clinical and radiological improvement was observed. The
present case indicates that the possibility of acute eosinophilic pneumoni
a should be fully considered in dialysis patients developing unexplained re
spiratory symptoms while on amitriptyline therapy.