An analysis of drug-induced liver injury, which showed histological findings similar to autoimmune hepatitis

• Published in: Journal of gastroenterology 2016-06, Vol.51 (6), p.597-607
• Main Authors: Hisamochi, Akiko, Kage, Masayoshi, Ide, Tatsuya, Arinaga-Hino, Teruko, Amano, Keisuke, Kuwahara, Reiichiro, Ogata, Kei, Miyajima, Ichiro, Kumashiro, Ryukichi, Sata, Michio, Torimura, Takuji
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Analysis; Autoantibodies; Biliary Tract; Biological products; Case-Control Studies; Chemical and Drug Induced Liver Injury - etiology; Chemical and Drug Induced Liver Injury - pathology; Chemical and Drug Induced Liver Injury - therapy; Chronic active hepatitis; Colorectal Surgery; Diagnosis, Differential; Drugs; Female; Fenofibrate; Gastroenterology; Hepatitis, Autoimmune - pathology; Hepatology; Humans; Immunoglobulin G; Liver; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Botanic; Medicine, Experimental; Medicine, Herbal; Middle Aged; Original Article—Liver; Pancreas; Recurrence; Risk Factors; Surgical Oncology
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-015-1131-7

Background Drug-induced liver injury (DILI) sometimes resembles autoimmune hepatitis (AIH) in its hepatic histology. However, there is lacking data of a comparison of the characteristics between such DILI and DILI without histological findings like AIH. Methods We enrolled 62 patients with DILI who were diagnosed using the Roussel Uclaf Causality Assessment Method, and performed a liver biopsy. These patients were classified into two groups: DILI with histology like AIH (group A, n  = 23) and DILI without such histology (group B, n  = 39). Sixteen patients of group A could be further classified into two groups: patients with relapse of the liver injury (group C, n  = 8) and without relapse (group D, n  = 8), after the recovery of the DILI. We compared the clinical and histological findings between group A and B, and group C versus D. Results Group A was characterized by an older age ( p  = 0.043), higher immunoglobulin G level ( p  = 0.017), positive antinuclear antibody status ( p  = 0.044), and a higher frequency of complementary alternative medicines and Chinese herbal medicines as the causative drug ( p  = 0.008). There were no significant differences between group C and D regarding the clinical data and liver histological findings. Conclusions The clinical characteristics of DILI, which showed histological findings similar to AIH, were revealed. In such patients, a liver biopsy is recommended in order to determine the appropriate treatment strategy. In DILI with histology like AIH patients, long-term follow-up is needed to perceive the relapse.