Acute liver failure after intravenous amiodarone: a case report

Abstract Background Acute liver failure (ALF) is a rare, life-threatening syndrome defined by acute liver injury, coagulopathy, and encephalopathy in patients without preexisting liver disease. Amiodarone, a class III antiarrhythmic, is associated with multisystem toxicity, but ALF has been reported only in a few cases. Case presentation A 50-year-old man presented to the emergency department with atrial fibrillation with rapid ventricular response. He was treated with intravenous (IV) amiodarone (300 mg bolus, then 900 mg/24 h infusion). Twelve hours later, he developed encephalopathy and laboratory evidence of ALF. Viral, autoimmune, and metabolic causes were excluded, and abdominal imaging was unremarkable. Amiodarone was discontinued, and he was admitted to the intensive care unit. Rate control was achieved with IV verapamil and improved within 72 h. The patient was discharged on day 6 with stable clinical status. Conclusions ALF after IV amiodarone is an uncommon but potentially fatal complication.