Amiodarone-induced hepatic and pulmonary toxicity

An 88-year-old woman presented with a 5-day history of nausea, vomiting and abdominal pain at the emergency department. Her medical history included sick sinus syndrome and atrial flutter, for which she underwent permanent pacemaker implantation and radiofrequency catheter ablation 4 and 6 months earlier, respectively. She had been prescribed amiodarone for 5 months (600 mg/day for 2 months, then 400 mg/day for 3 months) due to relapsing atrial flutter after ablation. The level of alanine aminotransferase was 45 U/L (reference range, 0–41), total bilirubin was 0.66 mg/dL (reference range, 0.3–1.0) and direct bilirubin was 0.55 mg/dL (reference range, 0.03–0.18). CT of the abdomen showed a distended gallbladder and confirmed the diagnosis of acute cholecystitis. Besides, the CT scan, obtained without the administration of contrast material, showed an increased density of the entire liver (figure 1A, arrows) and bilateral atelectatic lungs (figure 1B, arrows). The image findings were compatible with the diagnosis of amiodarone-induced hepatic and pulmonary toxicity. She received conservative treatment because of her old age and died 1 week after hospitalisation.