Liver and intrahepatic bile ducts-nontumor
Hepatitis - Drug / toxin induced

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

Revised: 12 October 2016, last major update May 2016

Copyright: (c) 2003-2016,, Inc.

PubMed Search: Hepatitis [title] amiodarone

Cite this page: Drug / toxin induced hepatitis, Amiodarone. website. Accessed October 20th, 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 Aug;6:465)
  • Dose related liver toxicity if > 200 mg daily
Clinical features
  • Asymptomatic hepatic dysfunction is common in patients receiving long term Amiodarone (15-30%) (JAMA 2007 Sep 19;298:1312)
  • Symptomatic hepatotoxicity is less common: 0.5-2.9% have clinically overt hepatitis (Hepatology 1989 May;9:679)
  • Fulminant acute liver failure and cirrhosis are rare
  • Long terms user should be monitored by serum alanine transaminase or aspartate transaminase every 6 months (JAMA 2007 Sep 19;298:1312)
Case reports
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 Jan;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 Jan;2:116)
Microscopic (histologic) images
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Amiodarone steatohepatitis:
marked hepatocyte ballooning,
numerous Mallory hyaline bodies
and minimal steatosis

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Hydropic swelling,
acidophil bodies,
cytoplasmic cholestasis

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Periportal Mallory

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: formation of lysosomal inclusion bodies
due to accumulation of amiodarone

Differential diagnosis