Abstract
Drug-induced liver injury (DILI) with features of autoimmunity (AI) represents an important category of hepatotoxicity due to medication exposure. Drugs repeatedly associated with AI-DILI include diclofenac, α-methyl DOPA, hydralazine, nitrofurantoin, minocycline, and more recently statins and anti-TNF-α agents. Usually, symptoms of acute liver injury occur within a few months after initiation of a culprit medication, but a longer latency period is possible. Like idiopathic autoimmune hepatitis, circulating autoantibodies and a hypergammaglobulinemia are frequently present in sera from patients with AI-DILI. If performed, a liver biopsy should demonstrate interface hepatitis with a prominent plasma cell infiltrate. The severity of AI-DILI is variable, but a complete resolution after withdrawal of the offending medication is the expectation. A response to corticosteroid therapy supports the diagnosis, whereas a lack of recurrence of symptoms or signs following corticosteroid cessation distinguishes AI-DILI from idiopathic autoimmune hepatitis.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Publication types
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Case Reports
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Research Support, N.I.H., Extramural
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Review
MeSH terms
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Adult
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Anti-Bacterial Agents / adverse effects
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Anti-Infective Agents, Urinary / adverse effects
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Antihypertensive Agents / adverse effects
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Autoantibodies / blood*
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Autoimmunity*
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Chemical and Drug Induced Liver Injury / complications
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Chemical and Drug Induced Liver Injury / diagnosis*
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Chemical and Drug Induced Liver Injury / genetics
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Chemical and Drug Induced Liver Injury / immunology*
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Chemical and Drug Induced Liver Injury / metabolism
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Cytokines / genetics
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Diagnosis, Differential
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Drug Hypersensitivity / diagnosis
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Drug Hypersensitivity / immunology
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Female
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HLA Antigens / genetics
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Hepatitis, Autoimmune / blood
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Hepatitis, Autoimmune / diagnosis*
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Humans
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Hydralazine / adverse effects
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Hypergammaglobulinemia / etiology
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Liver / pathology
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Liver Function Tests
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Male
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Methyldopa / adverse effects
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Minocycline / adverse effects
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Nitrofurantoin / adverse effects
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Time Factors
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Young Adult
Substances
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Anti-Bacterial Agents
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Anti-Infective Agents, Urinary
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Antihypertensive Agents
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Autoantibodies
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Cytokines
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HLA Antigens
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Hydralazine
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Methyldopa
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Nitrofurantoin
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Minocycline