Severe Hepatic Toxicity with Portal Hypertension: An Unusual but Preventable Complication of Amiodarone Therapy

Abstract

A 77 year old African American woman with atrial fibrillation treated with amiodarone 200 mg daily for 67 months presented with new onset ascites, watery diarrhea, and peripancreatic lymphadenopathy. She had a mild elevation of her transaminases and alkaline phosphatase, though initial workup centered on ruling out malignancy. Ultimately, her liver biopsy demonstrated evidence of amiodarone induced hepatotoxicity. She had persistent liver damage requiring frequent paracenteses. This case highlights the importance of reassessing the need for amiodarone and performing routine recommended screening of liver chemistries during treatment.