Probable early acute hepatitis with parenteral amiodarone

Area of Science:

• Cardiology
• Hepatology
• Clinical Pharmacology

Background:

• A 77-year-old male with myocardial infarction and chronic heart failure presented with atrial tachycardia.
• Initial hepatic function tests were normal prior to treatment.

Observation:

• The patient received parenteral amiodarone (2300 mg over 3 days) for cardiac management.
• Following treatment, the patient developed jaundice, elevated transaminases, and coagulopathy.

Findings:

• Liver biopsy revealed severe centrilobular necrosis, indicative of acute hepatitis.
• Common causes of liver disease were excluded clinically and through laboratory tests.
• Parenteral amiodarone was identified as the likely cause of acute hepatitis.

Implications:

• This case highlights a potential adverse effect of parenteral amiodarone.
• The findings suggest a possible immunologically mediated mechanism for amiodarone-induced liver injury.
• Further investigation into amiodarone's hepatotoxicity is warranted.