Drug-induced hepatitis: histologic clues to a difficult diagnosis

Feriyl Bhaijee, Robert A Anders

Research output: Contribution to journalReview article

Abstract

Drug-induced liver injury (DILI) results from two chief mechanisms of action: idiosyncratic hepatotoxicity, which typically manifests with prominent inflammation, and intrinsic hepatotoxicity, which demonstrates necrosis with negligible inflammation. Clinically, DILI is classified into hepatitic, cholestatic, or mixed presentations based on the pattern of liver enzyme elevation. As many etiologic factors can result in abnormal liver enzymes, the clinical clue to diagnosing DILI is symptomatic and biochemical improvement upon withdrawal of the offending agent. Histologically, DILI manifests in four main patterns of injury: i) inflammation-predominant acute hepatitis, ii) necrosis-predominant acute hepatitis, iii) resolving hepatitis, and iv) syncytial giant cell hepatitis. In contrast to the characteristic features of both acute hepatitis and syncytial giant cell hepatitis, resolving drug-induced hepatitis lacks specific histologic features and may mimic other mild forms of chronic hepatitis. Ultimately, the presence of sinusoidal PASD + Kupffer cell aggregates – in the absence of significant hepatocellular inflammation or injury – is the histologic hallmark of resolving drug-induced hepatitis.

Original languageEnglish (US)
Pages (from-to)559-562
Number of pages4
JournalDiagnostic Histopathology
Volume23
Issue number12
DOIs
StatePublished - Dec 1 2017

Keywords

  • DILI
  • drug injury
  • drug-induced
  • hepatitis
  • Kupffer cell
  • statin

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

Fingerprint Dive into the research topics of 'Drug-induced hepatitis: histologic clues to a difficult diagnosis'. Together they form a unique fingerprint.

  • Cite this