Multisystem Side Effects of Amiodarone

A 60-year-old man with medical history of atrial fibrillation on amiodarone 400 mg/d for 8 years was admitted for increased shortness of breath. On his general physical examination, he had grayish discoloration of face. Further workup included computed tomography (CT) of chest and upper abdomen, and bronchoscopy revealed increased attenuation of the liver and lung infiltrates. Amiodarone is an iodinated benzofuran derivative class 3 antiarrhythmic agent. It has multiple side effects, affects most of the organ systems of the human body including, eyes, thyroid, lungs, liver, brain and skin. Our patient had skin, lung and liver involvement. The patient had striking slate gray pigmentation of the face (Figure 1). The grayish blue color (ceruloderma) is due to the deposition of the melatonin and lipofuscin in macrophages and endothelial cells in the dermis, which is induced by amiodarone. Diffuse alveolar and interstitial infiltrates (Figure 2) due to diffuse alveolar hemorrhage were shown by serial bronchoalveolar lavage. CT of the liver showed increased liver density (116 H [Hounsfield units], normal range of liver 30–70 H) compared with that of the spleen and surrounding tissues, consistent with amiodarone injury (Figure 2).