title: Drug-induced liver injury with autoimmune features.
abstract: 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.
authors.affiliation: Department of Medicine, Center for Liver Diseases and Transplantation, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: deLemos
authors.affiliation: Immune Monitoring Core Laboratory, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: David M
authors.initials: DM
authors.lastname: Foureau
authors.affiliation: Department of Pathology, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Carl
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: Department of Pathology, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Will
authors.initials: W
authors.lastname: Ahrens
authors.affiliation: Department of Medicine, Center for Liver Diseases and Transplantation, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Russo
authors.affiliation: Department of Medicine, Center for Liver Diseases and Transplantation, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Herbert L
authors.initials: HL
authors.lastname: Bonkovsky
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000009:adverse effects; D001323:Autoantibodies / Q000097:blood*; D015551:Autoimmunity; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology* / Q000378:metabolism; D016207:Cytokines / Q000235:genetics; D003937:Diagnosis, Differential; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology; D005260:Female; D006680:HLA Antigens / Q000235:genetics; D019693:Hepatitis, Autoimmune / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D006830:Hydralazine / Q000009:adverse effects; D006942:Hypergammaglobulinemia / Q000209:etiology; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008750:Methyldopa / Q000009:adverse effects; D008911:Minocycline / Q000009:adverse effects; D009582:Nitrofurantoin / Q000009:adverse effects; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000892:Anti-Infective Agents, Urinary; D000959:Antihypertensive Agents; D001323:Autoantibodies; D016207:Cytokines; D006680:HLA Antigens; D006830:Hydralazine; D008750:Methyldopa; D009582:Nitrofurantoin; D008911:Minocycline