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Smoldering Amiodarone-Induced Decompensated Cirrhosis: Cumulative Dose-Related Toxicity
Jason Ta1,2, Ritesh Bhandari2, Joseph Di Francesco2
1School of Medicine, University of Tasmania, Hobart, Tasmania, Australia, utas.edu.au.
Case Reports in Gastrointestinal Medicine
|May 27, 2026
Summary
Long-term amiodarone use can lead to severe liver injury, even with subtle initial signs. This case highlights the importance of monitoring cumulative dosage and considering hepatic density on CT scans for early detection of amiodarone-induced liver damage.
Area of Science:
- Hepatology
- Pharmacology
- Radiology
Background:
- Amiodarone is a critical antiarrhythmic medication.
- Rarely, it can cause severe, progressive liver damage (hepatotoxicity).
- Early detection of amiodarone-induced liver injury (AILI) is challenging due to subtle initial symptoms.
Purpose of the Study:
- To report a case of severe, progressive AILI in a patient with long-term amiodarone therapy.
- To emphasize the diagnostic utility of CT imaging and liver biopsy in AILI.
- To highlight the need for vigilant monitoring in patients on chronic amiodarone.
Main Methods:
- Case report of a 74-year-old male on 12 years of amiodarone therapy.
- Clinical evaluation, liver function tests, quad-phase CT imaging, and liver biopsy were performed.
- Exclusion of secondary causes of liver disease.
Main Results:
- The patient developed ascites and cholestatic liver dysfunction.
- CT showed increased hepatic attenuation, indicating iodine deposition.
- Liver biopsy confirmed cirrhosis with features suggestive of AILI, including Mallory-Denk bodies.
- Discontinuation of amiodarone did not prevent decompensation.
Conclusions:
- AILI can progress subclinically, with nonspecific liver enzyme abnormalities.
- Increased hepatic density on noncontrast CT may indicate amiodarone deposition.
- Long-term monitoring of cumulative dose is crucial for preventing irreversible liver injury.
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