The clinical features of drug-induced liver injury observed through liver biopsy: focus on relevancy to autoimmune hepatitis.
OBJECTIVE
Accurate diagnosis of drug-induced liver injury (DILI) is difficult without considering the possibility of underlying diseases, especially autoimmune hepatitis (AIH). We investigated the clinical patterns in patients with a history of medication, liver-function abnormalities, and in whom liver biopsy was conducted, focusing on accompaniment by AIH.


METHODS
The clinical, serologic, and histologic findings of 29 patients were compared and analyzed. The patients were aged 46.2±12.8 years (mean±SD), and 72.4% of patient were female. The most common symptom and causal drug were jaundice (58.6%) and herbal medications (55.2%), respectively.


RESULTS
Aspartate aminotransferase (AST), alanine aminotransferase, total bilirubin, alkaline phosphatase, and γ-glutamyl transpeptidase levels were 662.2±574.8 U/L, 905.4±794.9 U/L, 12.9±10.8 mg/dL, 195.8±123.3 U/L, and 255.3±280.8 U/L, respectively. According to serologic and histologic findings, 21 cases were diagnosed with DILI and 8 with AIH. The AIH group exhibited significantly higher AST levels (537.1±519.1 vs. 1043.3±600.5 U/L), globulin levels (2.7±0.4 vs. 3.3±0.5 g/dL), and prothrombin time (12.9±2.4 vs. 15.2±3.9 s; P<0.05). Antinuclear antibody was positive in 7 of 21 cases of DILI and all 8 cases of AIH (P=0.002). The simplified AIH score was 3.7±0.9 in the DILI group and 6.5±0.9 in the AIH group (P<0.001).


CONCLUSIONS
Accurate diagnosis is necessary for patients with a history of medication and visits for liver-function abnormalities; in particular, the possibility of AIH should be considered.
Institute for Digestive Research, Digestive Disease Center, Depertment of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.
Hye Young
HY
Ju
Jae Young
JY
Jang
Soung Won
SW
Jeong
Sung Ae
SA
Woo
Min Gyu
MG
Kong
Hee Yoon
HY
Jang
Sae Hwan
SH
Lee
Sang Gyune
SG
Kim
Sang-Woo
SW
Cha
Young Seok
YS
Kim
Young Deok
YD
Cho
So Young
SY
Jin
Hong Soo
HS
Kim
Boo Sung
BS
Kim
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D005916:Globulins / Q000032:analysis; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000473:pathology; D029001:Herbal Medicine; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011517:Prothrombin Time
D000974:Antibodies, Antinuclear; D005916:Globulins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase