Amiodarone-induced liver injury with bright liver sign: A case report

Abstract

BACKGROUND

Amiodarone is an antiarrhythmic drug with well-recognized hepatotoxicity; however, its radiologic appearance mimicking hepatic iron deposition has been rarely reported. We describe a case in which the initial imaging findings were misinterpreted as hemochromatosis, whereas the final diagnosis was amiodarone-induced liver injury (AILI).

CASE SUMMARY

An 85-year-old woman received oral amiodarone hydrochloride for 5 months for the treatment of atrial fibrillation and subsequently developed recurrent nausea, vomiting, and progressive elevation of liver enzymes. Given the well-documented medication history and a Roussel Uclaf Causality Assessment Method score of 8, AILI secondary to intrahepatic drug deposition was clinically suspected. Non-contrast chest computed tomography (CT) demonstrated diffusely increased hepatic attenuation, and hemochromatosis was initially diagnosed on imaging. However, abdominal magnetic resonance imaging (MRI) revealed mildly decreased hepatic signal intensity on T2-weighted imaging without other characteristic features of iron overload, and iron studies were within normal limits. AILI was subsequently diagnosed. Following discontinuation of amiodarone, the patient’s gastrointestinal symptoms resolved, and liver enzyme levels gradually returned to baseline.

CONCLUSION

Amiodarone deposition within the liver can result in hepatic injury accompanied by diffuse hepatic hyperattenuation on CT, mimicking other conditions associated with increased liver attenuation. MRI plays a crucial role in differential diagnosis. By combining this case with a review of the relevant literature, we summarize the characteristic imaging features of AILI to facilitate its diagnosis and management.

Keywords: Amiodarone; Hepatic iodine deposition; Drug-induced liver injury; Computed tomography; Magnetic resonance imaging; Hemochromatosis; Case report

Core Tip: We report a case of amiodarone-induced hepatic iodine deposition and review the relevant literature to highlight the key distinguishing features between amiodarone-induced liver injury (AILI) and hemochromatosis. Although diffuse hepatic hyperattenuation on computed tomography can be easily misdiagnosed as hemochromatosis, a normal T2-weighted imaging (T2WI) signal on magnetic resonance imaging, in contrast to the diffuse hypointensity across all sequences typically observed in hemochromatosis, may aid in differential diagnosis. However, mildly decreased hepatic signal intensity on T2WI does not definitively exclude AILI. Normal serum iron parameters further support an accurate differential diagnosis.