Amiodarone-Induced Pneumonia Without Foamy Macrophages in the BALF: A Diagnostic Challenge Unveiled by Cryobiopsy.

A 64-year-old man with a mild cough presented with abnormal chest imaging with centrilobular ground-glass opacities in the upper lobes, peribronchovascular and subpleural consolidation and small nodules. Bronchoalveolar lavage fluid (BALF) lacked foamy macrophages, transbronchial lung cryobiopsy revealed features consistent with amiodarone-induced interstitial pneumonia, including vacuolization of type II alveolar epithelial cells, lymphoid follicle formation and granulation tissue. After discontinuation of amiodarone, the patient's symptoms and radiographic abnormalities improved. This case highlights that the absence of foamy macrophages in BALF should not preclude amiodarone-induced pneumonia, and that histological evaluation plays a pivotal role in establishing an accurate diagnosis.