Drug-induced steatohepatitis leading to cirrhosis: long-term toxicity of amiodarone use.
Nonalcoholic steatosis/steatohepatitis is the most common cause for abnormal liver chemistries. Apart from metabolic syndrome, drugs may also lead to development of steatohepatitis that may, rarely, progress to cirrhosis and portal hypertension. We discuss a case of amiodarone-induced steatohepatitis with advanced fibrosis, presenting with hepatic decompensation and portal hypertension manifesting as ascites and recurrent esophageal variceal hemorrhage. Amiodarone is a lipophilic drug that concentrates in the liver and usually, over a period of time, leads to toxicity related to drug accumulation. There is marked histological similarity between amiodarone-induced liver disease and alcoholic and nonalcoholic steatohepatitis. The clinical manifestations of amiodarone-induced hepatotoxicity and the mechanism of toxicity are also discussed.
Raja
Kaiser
K
Division of Liver Diseases, Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NewYork 10029, USA.
Thung
Swan N
SN
Fiel
M Isabel
MI
Chang
Charissa
C
D000368:Aged; D000638:Amiodarone / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000139:chemically induced; D005234:Fatty Liver / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D006975:Hypertension, Portal / Q000139:chemically induced; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008103:Liver Cirrhosis / Q000139:chemically induced* / Q000175:diagnosis; D012008:Recurrence; D013997:Time Factors
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone