Severe intrahepatic cholestasis caused by amiodarone toxicity after withdrawal of the drug - A case report and review of the literature

Choletasis has been reported as a rare presentation among patients with sev ere liver-injury secondary to amiodarone hepatic toxicity. We;report an unu sual case of amiodarone-induced cholestatic hepatotoxicity occurring after amiodarone had been discontinued and the initial abnormal liver function fi ndings had improved. The patient, without jaundice at the initial presentat ion, developed severe jaundice about 4 months after withdrawal of amiodaron e. Light and transmission. electron microscopic examination of a specimen s ecured by computed tomographically guided liver biopsy was consistent with amiodarone hepatic toxicity as the cause of intrahepatic cholestasis. An ab dominal ultrasound, endoscopic retrograde cholangiography, and dimethyl imi nodiacetic acid and computed tomographic scans off he abdomen all failed to demonstrate any other causes for jaundice other than amiodarone toxicity. Thus, amiodarone hepatic toxicity may occur after drug withdrawal even if r esults of liver function tests improve. Histopathologic examination of a li ver biopsy specimen is of value for diagnosis and prognosis. The liver biop sy findings, clinical course, and liver function test results are discussed , and the English-language literature on amiodarone cholestatic hepatotoxic ity is reviewed.