Amiodarone-Induced Multi-Systemic Toxicity Involving the Liver, Lungs, Thyroid, and Eyes: A Case Report

Abstract

ObjectivesAmiodarone is widely used to treat arrhythmia. However, amiodarone is known for its severe toxicity to the liver, lungs, and thyroid. Amiodarone causes liver damage ranging from asymptomatic serum aminotransferase elevation to hepatic failure requiring liver transplantation. Although amiodarone toxicity has been reported, its simultaneous multi-organ toxicity is not well-known. Here, we introduce a novel case of multi-systemic amiodarone toxicity involving the liver, lungs, thyroid, and eyes.Case PresentationA 61-year-old woman visited the emergency room due to general weakness, nausea, visual disturbance, heat intolerance, and a non-productive cough. The patient had been using clopidogrel and amiodarone due to underlying atrial fibrillation. The total level of bilirubin was 0.71 mg/dL, aspartate aminotransferase was 358 U/L, alanine aminotransferase was 177 U/L, and prothrombin time was 27.1 s. Computed tomography showed diffuse increased liver intensity and scattered hyperattenuated nodular consolidations in both lungs. Transthoracic needle lung biopsy revealed fibrinoid interstitial inflammation with atypical change of type II pneumocytes and intra-alveolar foamy macrophages. In addition, the thyroid-stimulating hormone level was <0.008 μIU/mL, and free thyroxine was 4.67 ng/dL. The thyroid scan showed diffuse homogenous intake of technetium-99 m pertechnetate in both thyroid lobes. The ophthalmologic exam detected bilateral symmetrical corneal deposits in a vortex pattern. With these findings, we could diagnose amiodarone-induced hepatic, pulmonary, thyroid, and ophthalmologic toxicity. Liver function was restored after cessation of amiodarone, and thyroid function was normalized with methimazole administration. However, due to aggravated lung consolidations, systemic steroid treatment was administered, and improvement was seen 1 week after, at the follow-up exam. As her symptoms improved, she was discharged with a plan of steroid administration for 3 to 6 months.ConclusionsThis case implies the possibility of multi-systemic amiodarone toxicity. Thus, the toxicity of amiodarone to multiple organs must be monitored. Prompt cessation of the drug should be considered upon diagnosis.

Too Little, Too Late: A Case of a Swift Fatal Culmination of Amiodarone Induced Pulmonary Toxicity in an Adult Male

“…Furthermore, despite the quick discontinuation of amiodarone and the use of intravenous pulsed methylprednisolone at high doses, it did not provide any rapid therapeutic relief or positive response as suggested commonly in literature. 4,10,15,16 These factors have all contributed to the rapidity and severity of APT in this patient. Though not previously highlighted in literature for the cut off for reversible versus non-reversible drug induced interstitial lung disease, it could be considered that this patient's APT may very well have been past that of a reversible stage.…”

“…It has an iodine containing compound, known as an iodinated benzofuran derivative, which is highly lipophilic, hence can accumulate in fat containing tissues and different organs such as lungs, liver, thyroid, eyes, and heart – mainly highly perfused organs. 1 , 3 , 4 However, pulmonary toxicity is the most serious of all these complications of amiodarone use. 2 , 5 , 6 Though it may occur with any dosage, the likelihood of pulmonary toxicity does decrease with lower doses of amiodarone.…”

Hepatic Encephalopathy Caused by Long-Term Amiodarone Use

“…Approximately 24% of patients taking amiodarone had asymptomatic elevated serum aminotransferase levels. In various studies, less than 1% of patients reported the development of significant drug-induced liver injury, ranging from symptomatic hepatitis and micronodular cirrhosis to liver failure requiring liver transplantation [ 9 ]. Acute hepatocellular injury occurred within 24 hours after the administration of intravenous amiodarone [ 10 ].…”

Two sides of the coin: Amiodarone-induced lung toxicity – Case Report

“…Liver function should be checked in people treated with this drug As previously mentioned, amiodarone is a lipophilic drug which can accumulate in the liver causing amiodaroneinduced liver disease, histologically similar to alcoholic and no-alcoholic steatohepatitis [15]. Amiodarone causes liver damage, ranging from asymptomatic increases in serum transaminases to liver failure requiring liver transplant [16]. Patients infected with the hepatitis B and C viruses are at high risk of developing cirrhosis.…”