Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2816
Peer-review started: April 16, 2014
First decision: May 13, 2014
Revised: October 7, 2014
Accepted: November 18, 2014
Article in press: November 19, 2014
Published online: March 7, 2015
Processing time: 327 Days and 12 Hours
We report a case of intravenous (IV) amiodarone drug induced liver injury (DILI). The patient received IV N-acetylcysteine (NAC) which resulted in a rapid improvement in liver enzymes. While the specific mechanisms for the pathogenesis of IV amiodarone DILI and the therapeutic action of IV NAC are both unknown, this case strongly implies at least some commonality. Because IV amiodarone is indicated for the treatment of serious cardiac arrhythmias in an intensive care unit setting, some degree of ischemic hepatitis is likely a cofactor in most cases.
Core tip: Intravenous (IV) amiodarone drug induced liver injury (DILI) is uncommon, and difficult to distinguish from ischemic hepatitis or congestive hepatopathy. Further, the pathophysiology is uncertain. IV N-acetylcysteine (NAC) is often used empirically as a treatment for idiopathic hepatitis or DILI. We report a case of rapid improvement of liver enzymes in a suspected case of IV amiodarone DILI with IV NAC, suggesting at least some shared features between the pathogenic mechanisms of the former and the therapeutic actions of the latter.