Hepatic Encephalopathy Caused by Long-Term Amiodarone Use

Area of Science:

• Hepatology
• Cardiology
• Pharmacology

Background:

• A 72-year-old woman with hypertrophic cardiomyopathy and ventricular tachycardia was treated with amiodarone for six years.
• Amiodarone is an antiarrhythmic drug with a known potential for various toxicities.

Observation:

• The patient presented with hepatic encephalopathy after cumulative amiodarone exposure.
• Imaging revealed diffuse increased liver parenchyma attenuation, consistent with a 'bright liver' on CT.
• Liver biopsy confirmed drug-induced steatohepatitis.

Findings:

• No urea cycle genetic variations were identified.
• The patient was diagnosed with drug-induced steatohepatitis and urea cycle abnormalities secondary to amiodarone.
• Amiodarone was implicated as the cause of hyperammonemia and subsequent hepatic encephalopathy.

Implications:

• This case illustrates the potential for amiodarone to induce steatohepatitis and urea cycle dysfunction.
• Understanding this mechanism is crucial for diagnosing amiodarone-related hyperammonemia.
• Highlights the importance of considering drug toxicity in patients with unexplained liver dysfunction and encephalopathy.