Oral Amiodarone-induced Liver Injury with Gamma Glutamyl Transferase Elevation: A Case Report
Amiodarone-induced hepatotoxicity varies from asymptomatic serum aminotransferase elevation to severe liver disease. Aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase are known to be elevated in amiodarone-induced liver damage. However, no study in the literature has reported that gamma glutamyl transferase (GGT) is elevated in this condition. Described is the case of an 82-year-old female patient with elevated GGT while using oral amiodarone for rapid response atrial fibrillation. The GGT level decreased after amiodarone was discontinued. GGT elevation was considered to be a potentially prominent drug side effect according to the Council for International Organizations of Medical Sciences/ Roussel Uclaf Causality Assessment Method scale. GGT is found in biliary epithelial cells and hepatocytes. GGT elevation may be due to drug or alcohol use. Histological changes in alcoholic liver disease and those in liver injury due to amiodarone toxicity are similar. It is thought that amiodarone-induced liver injury and GGT elevation are related to this histological similarity.
1. Fonseca P, Dias A, Gonçalves H, Albuquerque A, Gama V. Acute hepatitis after amiodarone infusion. World J Clin Cases 2015;3:900–3. [CrossRef]
2. Gluck N, Fried M, Porat R. Acute amiodarone liver toxicity likely due to ischemic hepatitis. Isr Med Assoc J 2011;13:748–52.
3. Pirovino M, Müller O, Zysset T, Honegger U. Amiodarone-induced hepatic phospholipidosis: correlation of morphological and biochemical findings in an animal model. Hepatology 1988;8:591–8. [CrossRef]
4. Lewis JH, Ranard RC, Caruso A, Jackson LK, Mullick F, Ishak KG, et al. Amiodarone hepatotoxicity: prevalence and clinicopathologic correlations among 104 patients. Hepatology 1989;9:679–85. [CrossRef]
5. Danan G, Benichou C. Causality assessment of adverse reactions to drugs--I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries. J Clin Epidemiol 1993;46:1323–30. [CrossRef]
6. Rockey DC, Seeff LB, Rochon J, Freston J, Chalasani N, Bonacini M, et al. Causality assessment in drug-induced liver injury using a structured expert opinion process: comparison to the Roussel-Uclaf causality assessment method. Hepatology 2010;51:2117–26. [CrossRef]
7. Arimone Y, Bégaud B, Miremont-Salamé G, Fourrier-Réglat A, Molimard M, Moore N, et al. A new method for assessing drug causation provided agreement with experts' judgment. J Clin Epidemiol 2006;59:308–14. [CrossRef]
8. Babany G, Mallat A, Zafrani ES, Saint-Marc Girardin MF, Carcone B, Dhumeaux D. Chronic liver disease after low daily doses of amiodarone. Report of three cases. J Hepatol 1986;3:228–32.
9. Kodavanti UP, Mehendale HM. Amiodarone- and desethylamiodarone-induced pulmonary phospholipidosis, inhibition of phospholipases in vivo, and alteration of [14C]amiodarone uptake by perfused lung. Am J Respir Cell Mol Biol 1991;4:369–78.
10. Lüllmann H, Lüllmann-Rauch R, Wassermann O. Lipidosis induced by amphiphilic cationic drugs. Biochem Pharmacol 1978;27:1103–8. [CrossRef]
11. Joshi UM, Kodavanti PR, Coudert B, Dwyer TM, Mehendale HM. Types of interaction of amphiphilic drugs with phospholipid vesicles. J Pharmacol Exp Ther 1988;246:150–7.
12. Poucell S, Ireton J, Valencia-Mayoral P, Downar E, Larratt L, Patterson J, et al. Amiodarone-associated phospholipidosis and fibrosis of the liver. Light, immunohistochemical, and electron microscopic studies. Gastroenterology 1984;86:926–36.
13. Somani P, Bandyopadhyay S, Klaunig JE, Gross SA. Amiodarone- and desethylamiodarone-induced myelinoid inclusion bodies and toxicity in cultured rat hepatocytes. Hepatology 1990;11:81–92. [CrossRef]
14. Bozbaş H, Yıldırır A, Karaçağlar E, Demir O, Ulus T, Eroğlu S, et al. Increased serum gamma-glutamyltransferase activity in patients with metabolic syndrome. Turk Kardiyol Dern Ars 2011;39:122–8. [CrossRef]
15. Goldberg DM, Martin JV. Role of gamma-glutamyl transpeptidase activity in the diagnosis of hepatobiliary disease. Digestion 1975;12:232–46. [CrossRef]
16. Sweeney BP, Bromilow J. Liver enzyme induction and inhibition: implications for anaesthesia. Anaesthesia 2006;61:159–77.
17. Andrade RJ, Robles M, Fernández-Castañer A, López-Ortega S, López-Vega MC, Lucena MI. Assessment of drug-induced hepatotoxicity in clinical practice: a challenge for gastroenterologists. World J Gastroenterol 2007;13:329–40. [CrossRef]