A Rare Case of Blue-Gray Discoloration Induced by Low-Dose Amiodarone

doi:10.1016/j.amjcard.2022.11.045

The American Journal of Cardiology

Volume 189, 15 February 2023, Pages 119-120

https://doi.org/10.1016/j.amjcard.2022.11.045 Get rights and content

Amiodarone is increasingly used in cardiology due to convenient dosing, low frequency of pro-arrhythmic effects, and good short term tolerance without significant hypotension. However, chronic use is associated with multisystem toxic side effects. We describe a rare case of amiodarone induced blue-gray skin discoloration.

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Case Presentation

A 76-year-old-woman with a history of atrial fibrillation, sick sinus syndrome, ischemic cardiomyopathy, and severe pulmonary arterial hypertension presented to our hospital with acute decompensated heart failure. Physical examination was notable for elevated jugular venous pressure, bilateral crackles, lower-extremity edema, irregularly irregular heart sounds, and slate-gray hyperpigmentation of forehead, cheeks, nail beds, and dorsum of the hands. (Figure 1.) Outpatient medications included

Disclosures

The authors have no conflicts of interest to declare.

References (3)

H Kuncipálová et al.
“Blue-grey syndrome”–a rare adverse effect of amiodarone
Cor Vasa
(2018)

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Cited by (1)

Side effects of positive inotropic drugs and drugs used in dysrhythmias
2023, Side Effects of Drugs Annual
This chapter summarizes the important side effects associated with positive inotropic drugs and antiarrhythmics reported in 2022 and early 2023. Digoxin toxicity can be precipitated by renal failure and furosemide. Although not all patients with digoxin toxicity are treated with digoxin immune Fab, digoxin immune Fab benefits patients with a shorter stay in the hospital and lower in-hospital mortality. Amiodarone can cause multiple organ dysfunction including liver and renal failure, hyperthyroidism, parkinsonism, and blue-man syndrome. It should be noted that intravenous amiodarone can cause hypotension. Notably, the first-published cases of amiodarone-induced visual and auditory hallucination and amiodarone-induced simultaneous damage to the liver, lungs, thyroid, and eyes were summarized. Flecainide can cause cardiac toxicities and organizing pneumonia. Flecainide overdose can cause altered mental status, seizure, and heart toxicity. Patients who have renal dysfunction or are poor metabolizers with a polymorphism on CYP2D6 may be highly susceptible to flecainide toxicity. No matter whether lidocaine is administered via infiltration injection, oral ingestion of lidocaine cream or topical lidocaine spray, or instillation to the bladder, lidocaine can cause status epilepticus, confusion, tachycardia, cardiac arrest, or death. Overdose of verapamil can cause hypotension, cardiac arrest, and metabolic acidosis. Intravenous lipid emulsion can be used to treat intoxications of flecainide, verapamil, or lidocaine. The first-reported cases of sotalol-induced IgA vasculitis and dobutamine-induced myoclonus in a patient on peritoneal dialysis were summarized. The studies summarized in this chapter raise awareness about rare or dangerous side effects of positive inotropes and antiarrhythmics.

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A Rare Case of Blue-Gray Discoloration Induced by Low-Dose Amiodarone

Section snippets

Case Presentation

Disclosures

Cor Vasa