Amiodarone-induced severe hepatitis mediated by immunological mechanisms

Area of Science:

• Hepatology
• Clinical Pharmacology
• Immunology

Background:

• Amiodarone is an antiarrhythmic drug frequently associated with various toxicities.
• Drug-induced liver injury (DILI) is a significant concern in clinical practice, requiring careful monitoring.

Observation:

• A 64-year-old male patient presented with fulminant hepatitis shortly after commencing amiodarone therapy.
• The patient exhibited a positive direct Coombs test, which resolved upon drug discontinuation.
• Re-administration of amiodarone triggered a recurrence of the positive Coombs test, suggesting an immune response.

Findings:

• The clinical presentation and laboratory findings strongly indicate amiodarone-induced autoimmune hepatitis.
• The positive Coombs test and rapid normalization of liver enzymes post-cessation point to an immune-mediated mechanism.
• Successful rechallenge confirmed the etiological role of amiodarone.

Implications:

• This case highlights the potential for amiodarone to cause rare, severe, and immune-mediated hepatitis.
• Clinicians should maintain high vigilance for this life-threatening adverse drug reaction, especially during initial treatment phases.
• Early recognition and withdrawal of amiodarone are crucial for patient recovery and preventing fatal outcomes.