title: Clinical features and outcomes of patients with drug-induced autoimmune hepatitis: a retrospective cohort study.
abstract: BACKGROUND
  Drugs and herbal products can induce autoimmune hepatitis. We assessed frequency and clinical outcomes of patients suffering from drug-induced autoimmune hepatitis.
  
  
  METHODS
  All patients with drug-induced liver injury admitted between 2000 and 2011 were retrospectively studied. Diagnoses of drug-induced autoimmune hepatitis and idiopathic autoimmune hepatitis were made according to simplified criteria. After discharge, all patients had regular follow-up and were contacted to update outcomes.
  
  
  RESULTS
  Among 10,270 in-hospital patients, 136 (1.3%) were diagnosed with drug-induced liver injury. Among them, 12 (8.8%) were diagnosed as drug-induced autoimmune hepatitis (41.7% males, age range 17-73); 8 (66.7%) were with jaundice at admission. Liver biopsies showed a pattern compatible with drug-induced autoimmune hepatitis, featured by severe portal inflammation and lymphoplasmacytic infiltrate. Drug-induced autoimmune hepatitis group had a shorter duration of drug intake, and higher values of transaminases and gamma globulins. All patients received immunosuppressive therapy with subsequent clinical remission, and five achieved a steroid-free long-term remission.
  
  
  CONCLUSIONS
  A diagnosis of drug-induced autoimmune hepatitis was quite rare in our cohort, and clinical pattern was similar to idiopathic autoimmune hepatitis. Severe portal inflammation, prominent portal-plasma cells, rosette formation and severe focal necrosis were significantly more frequent in drug-induced autoimmune hepatitis as compared to drug-induced liver injury.
authors.affiliation: Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Italy. Electronic address: anna.licata@unipa.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Licata
authors.affiliation: Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Maida
authors.affiliation: Section of Anatomical Pathology, University of Palermo, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Cabibi
authors.affiliation: Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Butera
authors.affiliation: Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Fabio S
authors.initials: FS
authors.lastname: Macaluso
authors.affiliation: Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Alessi
authors.affiliation: Section of Clinical Pathology, University of Palermo, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Caruso
authors.affiliation: Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
authors.affiliation: Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Piero L
authors.initials: PL
authors.lastname: Almasio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D019693:Hepatitis, Autoimmune / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Autoimmunity; Drug-induced liver injury; Human leucocyte antigens; Liver biopsy