Notice the central vein and necrosis of liver cells in all three zones of the lobule. A few cloisters of hepatocytes in form of cords and pseudo-ductules remain in the periphery of the lobule. Notice absence of inflammatory reaction and no endophlebites of the vein as it would be seen in viral hepatitis. The hepatic damage consist of cytoplasmic and canalicular cholestasis and with only portal inflammation with eosinophils. Cytonecrosis is minimal.
Prognosis is good.
The toxicity is dose related and occurs with more than 200mg daily. The changes in the liver consist of phospholipidosis and alcoholic-like changes with Mallory bodies in periportal hepatocytes and late periportal fibrosis. The accumulation of amiodarone in the liver can be assessed by computerized tomography because of the high iodine content of the drug. Its iodine is responsible for the thyroid dysfunction. This slide demonstrates hydropic swelling of hepatocytes, focal cell necrosis with inflammatory reaction and cytoplasmic cholestasis.