PMC

A, A 17-year-old white male taking minocycline for 2 years developed severe hepatitis. Minocycline was discontinued but then later resumed after normalization of liver biochemistries. Liver biopsy 2 months after rechallenge (ALT 628) showed moderate portal inflammation (P), interface hepatitis and scattered foci of lobular inflammation and apoptosis (arrows) (original magnification ×400). Liver dysfunction resolved with steroids. B, A 16-year-old white female developed cholestatic hepatitis 2 weeks after starting drospirenone/ethinyl estradiol birth control pills. Biopsy 4 weeks after DILI onset showed prominent canalicular cholestasis (arrows) near the central vein (V) with lobular inflammation (L) and rare apoptotic cells. Portal inflammation was also present (not shown) (original magnification ×400). C, A 10-year-old female with vanishing bile duct syndrome caused by azithromycin. Biopsy 2 weeks after DILI onset showed minimal inflammation, but most portal areas lacked bile ducts. A representative duct-less portal area is shown with portal vein (V) and hepatic artery (A) indicated (original magnification ×600).