Acute Liver Failure Associated With Intravenous Amiodarone: A Case Report

Amiodarone is a widely used class III antiarrhythmic agent that is indicated for the management of supraventricular and ventricular arrhythmias. Although mild elevations in liver enzymes are relatively common during therapy, severe hepatotoxicity and acute liver failure remain rare, yet potentially fatal complications, particularly when following intravenous administration. We report the case of an 80-year-old male who presented with palpitations and was diagnosed with atrial fibrillation with rapid ventricular response. Intravenous amiodarone was initiated for rhythm control. Within 14 hours, the patient developed rapidly progressive hepatocellular injury with marked elevation of transaminases, hyperbilirubinemia, and severe coagulopathy. Liver injury occurred while the patient remained hemodynamically stable, making ischemic hepatitis less likely, although it could not be completely excluded. Viral hepatitis was excluded, and imaging demonstrated no biliary obstruction. The patient's condition deteriorated rapidly, progressing to fulminant hepatic failure, metabolic acidosis, and multiorgan dysfunction, ultimately resulting in death despite aggressive supportive management.  This case highlights a possible association between intravenous amiodarone and acute liver failure. While the temporal relationship suggests a drug-induced liver injury, a multifactorial etiology, including potential contributions from hypoxia or other systemic factors, cannot be entirely excluded. This report underscores the importance of early recognition and careful monitoring for severe hepatic complications in patients receiving intravenous amiodarone.