Amiodarone-induced liver injury with bright liver sign: A case report

Amiodarone is an antiarrhythmic drug with well-recognized hepatotoxicity; however, its radiologic appearance mimicking hepatic iron deposition has been rarely reported. We describe a case in which the initial imaging findings were misinterpreted as hemochromatosis, whereas the final diagnosis was amiodarone-induced liver injury (AILI).

An 85-year-old woman received oral amiodarone hydrochloride for 5 months for the treatment of atrial fibrillation and subsequently developed recurrent nausea, vomiting, and progressive elevation of liver enzymes. Given the well-documented medication history and a Roussel Uclaf Causality Assessment Method score of 8, AILI secondary to intrahepatic drug deposition was clinically suspected. Non-contrast chest computed tomography (CT) demonstrated diffusely increased hepatic attenuation, and hemochromatosis was initially diagnosed on imaging. However, abdominal magnetic resonance imaging (MRI) revealed mildly decreased hepatic signal intensity on T2-weighted imaging without other characteristic features of iron overload, and iron studies were within normal limits. AILI was subsequently diagnosed. Following discontinuation of amiodarone, the patient's gastrointestinal symptoms resolved, and liver enzyme levels gradually returned to baseline.

Amiodarone deposition within the liver can result in hepatic injury accompanied by diffuse hepatic hyperattenuation on CT, mimicking other conditions associated with increased liver attenuation. MRI plays a crucial role in differential diagnosis. By combining this case with a review of the relevant literature, we summarize the characteristic imaging features of AILI to facilitate its diagnosis and management.