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Semin Liver Dis. 2014 May;34(2):194-204. doi: 10.1055/s-0034-1375959. Epub 2014 May 31.

Drug-induced liver injury with autoimmune features.

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Department of Medicine, Center for Liver Diseases and Transplantation, Carolinas Medical Center, Charlotte, North Carolina.
Immune Monitoring Core Laboratory, Carolinas Medical Center, Charlotte, North Carolina.
Department of Pathology, Carolinas Medical Center, Charlotte, North Carolina.


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.

[Indexed for MEDLINE]

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