case_images: PMC11288934_01
case_images: Electrocardiograms before amiodarone administration (2021.09.02), at the onset of organ damage (2023.08.13), and 1 week after discontinuation of the amiodarone (2023.08.21). (A) Electrocardiogram before amiodarone administration shows sinus rhythm with ST-T segment changes. (B) Electrocardiogram at the onset of organ damage shows sinus bradycardia; prolonged PR interval; widened P wave suggesting possible intra-atrial block; high voltage of left ventricular; increased U wave. (C) Electrocardiogram 1 week after discontinuation of the amiodarone shows sinus bradycardia; 1-degree atrioventricular block; T-wave change.
case_images: fcvm-11-1401049-g001.jpg
case_images: PMC11288934_01_fcvm-11-1401049-g001.jpg
case_images: F1
case_images: The electrocardiogram demonstrated sinus bradycardia, prolonged PR interval, P wave widening suggestive of intra-atrial block, high voltage of left ventricular, and increased U wave amplitude (Figure 1). The patient exhibited mild hypokalemia, which rapidly improved with oral potassium supplementation.
case_images: Imaging changes before (2022.02.14), at the onset of organ damage (2023.08.16), and 6 months (2024.02.09) after discontinuation of the amiodarone. (A-D) After 1 year (2022.02.14) of treatment with oral amiodarone (0.2 g/day), diffusely distributed ground-glass density shadows were seen in both lungs, with perifollicular hyperdense shadows, which were considered to be organizing pneumonia; the liver was hyperdense with a CT value of about 104 hu. (E-J) After 2 years (2023.08.16) of oral treatment with amiodarone, chest CT showed diffuse ground-glass shadows and fine reticular shadows in both lungs, with thickening of the interlobular septum, which was more significant than before; the density of the liver was markedly higher than before, with a CT value of about 145 HU. MRI of the liver showed the hepatic parenchyma was isointense on T1WI, and isointense on the fat-suppressed sequence of T2WI. (K-N) After stopping taking amiodarone for 6 months (2024.02.09), most of the lung lesions disappeared, and the density of the liver decreased, the CT value was about 93 HU.
case_images: fcvm-11-1401049-g002.jpg
case_images: PMC11288934_01_fcvm-11-1401049-g002.jpg
case_images: F2
case_images: Chest CT scanning showed diffuse ground-glass density shadow and fine reticular shadow in both lungs, and thickening of interlobular septum; abdominal CT scanning showed diffuse increase in liver density, with a CT value of 125-164 HU, which was considered to be iron overload, but further MRI scanning and enhancement examination of liver showed that the liver parenchymal signal did not show abnormally low on T2-weighted imaging, which was excluded (Figure 2). Retrospective lung CT analysis from an annual check-up suggested amiodarone-associated pulmonary mechanized pneumonitis and liver density increase (Figure 2). After discontinuing amiodarone for sotalol, her symptoms improved, and follow-up tests 6 months later showed normalized thyroid and liver functions (Figure 3), with lung CT indicating interstitial fibrosis absorption and reduced liver density (Figure 2).
case_images: Hospital course of the patient. (A) Course of AST and ALT. (B) Course of TSH, FT3 and FT4. AST, aspartate aminotransferase; ALT, alanine aminotransferase; TSH, thyroid-stimulating hormone; FT4, free thyroxine; FT3, free triiodothyronine.
case_images: fcvm-11-1401049-g003.jpg
case_images: PMC11288934_01_fcvm-11-1401049-g003.jpg
case_images: F3
case_images: After discontinuing amiodarone for sotalol, her symptoms improved, and follow-up tests 6 months later showed normalized thyroid and liver functions (Figure 3), with lung CT indicating interstitial fibrosis absorption and reduced liver density (Figure 2).