A Case of Drug-induced Hepatotoxicity: Amiodarone is Not Always to Blame

Case Presentation A 54 year-old male presented to the hospital with a two weekhistory of new onset jaundice, anorexia and fatigue. Thepatient has a past medical history of hypertension, coronaryartery disease, and ischemic cardiomyopathy with an ejectionfraction of 10% to 15%. He also has a history of atrial fibrillationand paroxysmal ventricular tachycardia with an automatedimplantable cardioverter-defibrillator placed. He deniedany history of blood transfusions, alcohol use, intravenousdrug abuse, or known hepatitis. He also denied taking herbalmedications or vitamins. The patient denied fevers, night sweats,nausea, shortness of breath, abdominal pain, blood in his stool,or easy bruising. Four weeks prior to admission, the patientwas diagnosed with hyperthyroidism thought to be secondary tolong-term amiodarone use which the patient had been taking foreight years for treatment of atrial fibrillation. At that time he wasstarted on 10 mg of methimazole daily, and his amiodarone wasstopped. All of his other medications were chronic and includeatenolol, pantoprazole, aspirin, clopidogrel, and furosemide. Hehas no known drug allergies. Upon admission his methimazolewas stopped since his symptoms could be attributable to this medication

A Woman With Chest Pain, Syncope, and Transaminitis

Case Presentation The patient is a 49 year-old female with past medical history ofanxiety and hyperlipidemia who presented to an outside hospitalwith complaints of five hours of substernal chest pain followed bythree episodes of syncope witnessed by her son. At presentationin the emergency department the patient denied any currentchest pain or shortness of breath. She received 325 mg of aspirinen route to the hospital by EMS. Her vital signs were temperature100° Fahrenheit, heart rate 60 beats/minute, blood pressure101/50 mm Hg, respiratory rate 20 breaths/minute, and a pulseoxygenation of 98% on room air. The patient’s EKG showed STelevations in the inferior leads. The patient’s laboratory studieswere: white blood cell (wbc) count 14 B/L, hemoglobin 13.2 g/dL, platelets 153 B/L, CKMB 32 U/L, troponin 8.27 ug/L, andCK 24.5 U/L. The patient was started on intravenous heparinand integrillin drips and transferred to Jefferson for emergentcardiac catheterization