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Aliment Pharmacol Ther. 2007 Jun 15;25(12):1411-21.

The impact of eosinophilia and hepatic necrosis on prognosis in patients with drug-induced liver injury.

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  • 1Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden.



Drug-induced liver injury may be immunologically mediated or metabolically induced. Peripheral eosinophilia and liver eosinophilia in suspected drug-induced liver injury generally supports the role of drug aetiology.


To assess the importance of eosinophilia and hepatic necrosis on outcome in patients with suspected drug-induced liver injury.


We performed search of MEDLINE for case reports on drug-induced liver injury associated with: amoxicillin/clavulanic acid, carbamazepine, diclofenac, disulfiram, erythromycin, flucloxacillin, halothane, isoniazid, phenytoin, sulindac and trimethoprim/sulfametoxazol.


A total of 570 case reports were retrieved. Mortality/transplantation occurred in 112 (20%). Eosinophilia in peripheral blood was reported in 34% of cases, eosinophilia in liver biopsies in 40%, and hepatic necrosis in 41%. Bilirubin levels were lower in patients with peripheral eosinophilia [5.5 x upper limit of normal (interquartile range 2.9-10) vs. 7.7 (4-17); P = 0.02] and patients with liver eosinophilia [5 x upper limit of normal (2.7-10) vs. 10 (5.4-20); P = 0.003] as compared with those without eosinophilia. Eosinophilia in peripheral blood and eosinophilia in liver biopsies were more common in patients who recovered (37% vs. 15.6%; P = 0.0001 and 48% vs. 18.8%; P < 0.0001, respectively). Hepatic necrosis was present in 24% in the survivors vs. 84% in non-survivors (P < 0.0001).


In drug-induced liver injury, a favourable outcome was related to the occurrence of eosinophilia, whereas hepatic necrosis was associated with a poor prognosis.

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