Case Report
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2005; 11(34): 5394-5397
Published online Sep 14, 2005. doi: 10.3748/wjg.v11.i34.5394
Liver cirrhosis induced by long-term administration of a daily low dose of amiodarone: A case report
Hiroki Oikawa, Chihaya Maesawa, Ryo Sato, Kanta Oikawa, Hiroyuki Yamada, Seizo Oriso, Sadahide Ono, Akiko Yashima-Abo, Koji Kotani, Kazuyuki Suzuki, Tomoyuki Masuda
Hiroki Oikawa, Chihaya Maesawa, Kanta Oikawa, Akiko Yashima-Abo, Koji Kotani, Tomoyuki Masuda, Department of Pathology, Iwate Medical University School of Medicine, Morioka, Japan
Ryo Sato, Kazuyuki Suzuki, Department of Internal Medicine I, Iwate Medical University School of Medicine, Morioka, Japan
Hiroyuki Yamada, Seizo Oriso, Department of Internal Medicine, Iwate Prefectural Ninohe Hospital, Ninohe, Japan
Sadahide Ono, Department of Pathology, Iwate Prefectural Central Hospital, Morioka, Japan
Author contributions: All authors contributed equally to the work.
Supported by Grants-in-Aid No. 16590289, 16790211 and 16790212, and “Open Research Center” Project for Private Universities: Matching fund Subsidy (2004-2008), from Ministry of Education, Culture, Sports, Science and Technology, Japan
Correspondence to: Dr. Chihaya Maesawa, Department of Pathology, Iwate Medical University School of Medicine, Uchimaru 19-1, Morioka 020-8505, Japan.
Telephone: +81-19-651-5111 Fax: +81-19-629-9340
Received: January 18, 2005
Revised: April 3, 2005
Accepted: April 9, 2005
Published online: September 14, 2005

The anti-arrhythmic agent amiodarone (AD) is associated with numerous adverse effects, but serious liver disease is rare. The improved safety of administration of daily low doses of AD has already been established and this regimen is used for long-term medication. Nevertheless, asymptomatic continuous liver injury by AD may increase the risk of step-wise progression of non-alcoholic fatty liver disease. We present an autopsy case of AD-induced liver cirrhosis in a patient who had been treated with a low dose of AD (200 mg/d) daily for 84 mo. The patient was a 85-year-old male with a history of ischemic heart disease. Seven years after initiation of treatment with AD, he was admitted with cardiac congestion. The total dose of AD was 528 g. Mild elevation of serum aminotransferase and hepatomegaly were present. Liver biopsy specimens revealed cirrhosis, and under electron microscopy numerous lysosomes with electron-dense, whorled, lamellar inclusions characteristic of a secondary phospholipidosis were observed. Initially, withdrawal of AD led to a slight improvement of serum aminotransferase levels, but unfortunately his general condition deteriorated and he died from complications of pneumonia and renal failure. Long-term administration of daily low doses of AD carries the risk of progression to irreversible liver injury. Therefore, periodic examination of liver function and/or liver biopsy is required for the management of patients receiving long-term treatment with AD.

Keywords: Amiodarone, Liver cirrhosis, NASH, NAFLD, Liver biopsy