Granular cells as a marker of early amiodarone hepatotoxicity

Hepatotoxicity due to chronic amiodarone (AD) use is well described. Howeve r, hepatitis occurring after acute administration of AD has only occasional ly been reported and the pathologic findings in the liver in this condition have not been well characterized. We describe an idiosyncratic reaction, i n a 40-year-old man after 6 weeks of oral AD therapy, consisting of acute h epatitis, which resolved after withdrawal of the drug. The liver biopsy sho wed clusters of cells with granular cytoplasm. These cells were characteriz ed as macrophages, and phospholipid membranous inclusions were demonstrated ultrastructurally in the granular cells and in the hepatocytes. Pathologis ts and clinicians should be aware of this subtle histologic finding when lo oking for evidence to support AD hepatotoxicity.