Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4958-4965
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4958
Amiodarone-induced hepatotoxicity — quantitative measurement of iodine density in the liver using dual-energy computed tomography: Three case reports
Hai-Juan Lv, Hong-Wei Zhao
Hai-Juan Lv, Hong-Wei Zhao, Department of Radiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
Author contributions: Lv HJ performed the literature search and drafted the manuscript; Zhao HW designed the study and reviewed the final manuscript; all authors have read and approved the final manuscript.
Supported by Science and Technology Bureau of Jiaxing, Zhejiang Province of China, No. 2017BY18018.
Informed consent statement: This study was approved by the Ethics Committee of the Second Affiliated Hospital of Jiaxing University. The three patients gave written informed consent prior to the computed tomography examination.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Wei Zhao, MD, Chief Doctor, Department of Radiology, The Second Affiliated Hospital of Jiaxing University, No.1518 Huancheng North Road, Jiaxing 314000, Zhejiang Province, China. zhw0314@hotmail.com
Received: March 31, 2020
Peer-review started: March 31, 2020
First decision: August 23, 2020
Revised: August 29, 2020
Accepted: September 10, 2020
Article in press: September 10, 2020
Published online: October 26, 2020
Processing time: 208 Days and 21.5 Hours
Abstract
BACKGROUND

Amiodarone is the drug most commonly used to manage arrhythmias. Long-term amiodarone administration causes hepatotoxicity due to iodine accumulation in the liver. Here, we present three cases of amiodarone-induced hepatotoxicity in patients on long-term oral amiodarone therapy who underwent dual-energy computed tomography (DECT).

CASE SUMMARY

We report the clinical and iodine density in the liver using DECT in three patients with amiodarone-induced hepatotoxicity. Liver enzymes were increased in these three patients, and abdominal DECT without contrast medium showed highly increased attenuation in the liver. Furthermore, the iodine concentration in the liver was increased. The first patient with amiodarone-induced reversible hepatotoxicity, showed a reversible course of liver function and a decrease in CT values after discontinuation of amiodarone. The second patient on long-term oral amiodarone had increased iodine concentration in the liver and liver damage, the patient eventually developed rapidly progressive pneumonia and died of multiple organ failure. The third patient, showed an increased iodine concentration in the liver and elevated liver enzymes. However, the patient refused radiofrequency ablation for atrial fibrillation and continued oral amiodarone to control atrial fibrillation, and routine liver function tests were required every 3-6 mo in this patient.

CONCLUSION

DECT is a potentially noninvasive diagnostic tool for quantifying iodine concentration in the liver and monitoring adverse reactions due to amiodarone.

Keywords: Case report; Amiodarone; Hepatotoxicity; Iodine density; Computed tomography; Dual energy; Arrhythmias

Core Tip: Amiodarone is the drug most commonly used to manage arrhythmias. Long-term amiodarone administration causes hepatotoxicity due to iodine accumulation in the liver. Our study investigated three patients receiving low-dose oral amiodarone therapy for the long-term prevention of paroxysmal atrial fibrillation in whom quantitative measurement of the iodine concentration in the liver was measured using dual-energy computed tomography. Dual-energy computed tomography is a potentially noninvasive diagnostic tool for quantifying iodine concentration in the liver and monitoring adverse reactions due to amiodarone.