Abstract
BackgroundAmiodarone is an antiarrhythmic drug that has been recognized to induce hepatotoxicity. We report a case of acute-on-chronic liver failure (ACLF) in a patient who was receiving amiodarone for more than 2 years. The patient developed cirrhosis and suppurative microabscesses of the liver and died of progressive liver failure.Case presentationA 69-year-old woman with risk factors for nonalcoholic fatty liver disease (NAFLD) was treated with oral amiodarone at a daily dose of 400 mg for more than 2 years, until she developed epigastralgia and vomiting. Initial laboratory findings included leukocytosis and elevated liver enzymes. Images of abdominal computed tomography scan revealed diffusely increased hepatic attenuation density (in contrast to decreased density in NAFLD), hepatomegaly, periportal edema, and ascites. Liver biopsy targeting the hotspot identified through positron emission tomography confirmed the diagnosis of amiodarone-associated chronic steatohepatitis and superimposed microabscesses. The patient died of progressive ACLF despite intensive supportive care.ConclusionAccumulation of amiodarone can result in chronic liver disease and pose an additional risk of ACLF following infection.
Highlights
Amiodarone is an antiarrhythmic drug that has been recognized to induce hepatotoxicity
Accumulation of amiodarone can result in chronic liver disease and pose an additional risk of acute-on-chronic liver failure (ACLF) fol‐ lowing infection
Acute-on-chronic liver failure (ACLF) is a process of rapid deterioration in liver function occurring against a background of chronic liver disease characterized by multisystem organ failure, systemic inflammation, and high short-term mortality
Summary
Amiodarone is an antiarrhythmic drug that has been recognized to induce hepatotoxicity. Conclusion: Accumulation of amiodarone can result in chronic liver disease and pose an additional risk of ACLF fol‐ lowing infection. Chronic liver disease is infrequently caused by potential hepatotoxic agents, such as amiodarone [1]. We report a rare case of ACLF caused by acute suppurative microabscesses superimposed on chronic drug-induced liver injury (DILI) associated with amiodarone.
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