title: Characteristics of liver injury in drug-induced systemic hypersensitivity reactions.
abstract: BACKGROUND
  The liver is the most commonly involved internal organ in drug-induced systemic hypersensitivity. However, data obtained from these patients have yet to be analyzed in depth with respect to liver injury.
  
  
  METHODS
  The medical records of 136 patients who developed delayed-type drug hypersensitivity were reviewed at a tertiary referral hospital. Culprit drugs, the pattern and degree of liver injury, and the effect of systemic corticosteroids were evaluated in the group of patients with drug-induced systemic hypersensitivity and liver dysfunction (aspartate aminotransferase or alanine aminotransferase ≥80 IU/L). Clinical characteristics of patients with drug-induced systemic hypersensitivity and liver injury were analyzed.
  
  
  RESULTS
  Among the 61 patients with drug-induced systemic hypersensitivity and liver dysfunction, the clinical phenotypes were drug reaction with eosinophilia and systemic symptoms (n = 29, 48%), Stevens-Johnson syndrome/toxic epidermal necrolysis (n = 11, 18%), and maculopapular rash (n = 17, 28%). Antibiotics (n = 27, 44%) were the most common cause of drug-induced systemic hypersensitivity with liver dysfunction. Whereas patients with Stevens-Johnson syndrome/toxic epidermal necrolysis had mild hepatocellular-type liver injury of relatively brief duration, those with drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome had more severe and prolonged hepatocellular injury in addition to moderate to severe cholestatic-type liver injury. The use of systemic corticosteroids did not significantly affect either recovery from liver injury or mortality.
  
  
  CONCLUSIONS
  This study was retrospective and the number of subjects was small.
  
  
  CONCLUSIONS
  The results suggest that the severity, pattern, and duration of liver injury differ according to the drug-hypersensitivity phenotype. Further studies are needed to evaluate the role of systemic corticosteroids in drug-induced systemic hypersensitivity and liver injury.
authors: Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Taehoon
authors: T
authors: Lee
authors: Yoon Su
authors: YS
authors: Lee
authors: Sun-Young
authors: SY
authors: Yoon
authors: Sujeong
authors: S
authors: Kim
authors: Yun-Jeong
authors: YJ
authors: Bae
authors: Hyouk-Soo
authors: HS
authors: Kwon
authors: You Sook
authors: YS
authors: Cho
authors: Hee-Bom
authors: HB
authors: Moon
authors: Tae-Bum
authors: TB
authors: Kim
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000493:Allopurinol / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D001219:Aspartate Aminotransferases / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D004342:Drug Hypersensitivity / Q000150:complications* / Q000188:drug therapy; D004791:Enzyme Inhibitors / Q000009:adverse effects; D004802:Eosinophilia / Q000139:chemically induced / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000188:drug therapy / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D004791:Enzyme Inhibitors; D000493:Allopurinol; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: ADR; ALT; AST; DRESS; DiHS; SJS; Stevens-Johnson syndrome; TEN; adverse drug reaction; alanine aminotransferase; aspartate aminotransferase; corticosteroid; drug hypersensitivity; drug reaction with eosinophilia and systemic symptoms; drug-induced hypersensitivity syndrome; drug-induced liver injury; toxic epidermal necrolysis