Liver and intrahepatic bile ducts - nontumor
Hepatitis (drug / toxin induced)
Amiodarone

Author: Anthony W.H. Chan, FRCPA (see Authors page)

Revised: 31 October 2017, last major update May 2016

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Hepatitis[TI] amiodarone[TI]

Cite this page: Chan, A.W.H. Drug / toxin induced hepatitis - amiodarone. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/liverdrugtoxinamiodarone.html. Accessed December 17th, 2017.
Definition / general
  • Amiodarone is a class III antiarrhythmic medication used in virtually all forms of supraventricular and ventricular tachycardia (Vasc Health Risk Manag 2010;6:465)
  • Dose related liver toxicity if > 200 mg daily
Epidemiology
Clinical features
  • Asymptomatic hepatic dysfunction is common in patients receiving longterm amiodarone (15 - 30%) (JAMA 2007;298:1312)
  • Symptomatic hepatotoxicity is less common: 0.5 - 2.9% have clinically overt hepatitis (Hepatology 1989;9:679)
  • Fulminant acute liver failure and cirrhosis are rare
Laboratory
  • Longterm users should be monitored by serum alanine transaminase or aspartate transaminase every 6 months (JAMA 2007 Sep 19;298:1312)
Case reports
Treatment
Microscopic (histologic) description
  • Steatosis, both macrovesicular and microvesicular, is most frequent finding; may be accompanied by ballooning degeneration and Mallory-Denk bodies (Hum Pathol 1990;21:59)
  • Variable degree of fibrosis and even cirrhosis may be found
  • Panacinar necrosis is seen in fulminant acute liver (ACG Case Rep J 2015;2:116)
Microscopic (histologic) images

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Amiodarone steatohepatitis

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Hydropic swelling,
inflammation,
acidophil bodies,
cytoplasmic cholestasis

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Periportal Mallory bodies

Electron microscopy description
Electron microscopy images

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Mallory bodies

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Giant mitochondria

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Myelin figures

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Phospholipidosis