Ground-glass opacity caused by the administration of amikacin liposome inhalation suspension: A case report

Abstract Background: Amikacin liposome inhalation suspension (ALIS) is a key drug for the treatment of refractory Mycobacterium avium complex pulmonary disease (MAC-PD), but causes hypersensitivity pneumonitis in rare cases. Case presentation: A 72-year-old woman was treated with ALIS for refractory MAC-PD. Three weeks later, she was hospitalized for pneumonia. The nose swab PCR test for coronavirus disease 2019, and serum (1,3)-beta-D-glucan test, were negative. Because the opacities worsened after empiric antibiotic therapy, we started corticosteroids, suspecting drug-induced interstitial lung disease (DIILD) caused by ALIS; 3 days later, we found signs of improvement and quickly tapered the corticosteroids. After obtaining informed consent, we performed a drug provocation test of ALIS. Seven days later, she had a re-exacerbation of MAC-ID, leading to a diagnosis of DIILD caused by ALIS. Conclusions: DIILD caused by ALIS is rare, but should be carefully diagnosed because various opacities appear on chest radiograph during the chronic course of the disease.