Clinical and histological features of idiosyncratic liver injury: Dilemma in diagnosis of autoimmune hepatitis.
OBJECTIVE
Drug-induced liver injury (DILI) is becoming a worldwide problem with its still unexplained properties.


METHODS
The data of patients who were diagnosed with DILI between January 2008 and December 2013 were assessed.


RESULTS
Five patients had been diagnosed with intrinsic and 82 patients with idiosyncratic DILI. The most common causative agents were antimicrobial drugs. The most common injury pattern was hepatocellular. When patients with bilirubin levels of more than 5 mg/dL were divided into two groups according to receiving steroid therapy (n = 11) or not (n = 40), there was not any significant difference according to their clinical results (P > 0.05). Five of the idiosyncratic DILI patients were diagnosed with drug-induced autoimmune hepatitis (DI-AIH). In histopathological examination, hepatic rosette formation and emperipolesis were observed to be more common among patients with DI-AIH when compared with ones without (P < 0.05). Interestingly, in the remaining patients with DILI (n = 77), three of them were diagnosed with classic autoimmune hepatitis during long-term follow up (range, 11-51 months).


CONCLUSIONS
The most common causes were antimicrobials, but any agents that have not been defined to cause DILI can induce DILI. The efficacy of steroids in DILI has not been observed but all deaths were observed in the steroid-free group. The association of DILI and AIH was observed in two different types in terms of diagnosis in our study. The first association was DI-AIH. The second one is the classical AIH which developed in three patients after a few months following spontaneous recovery of DILI.
Departments of Gastroenterology, Ankara, Turkey.
Ufuk Bariş
UB
Kuzu
Departments of Gastroenterology, Ankara, Turkey.
Erkin
E
Öztaş
Pathology, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
Nesrin
N
Turhan
Departments of Gastroenterology, Ankara, Turkey.
Fatih
F
Saygili
Departments of Gastroenterology, Ankara, Turkey.
Nuretdin
N
Suna
Departments of Gastroenterology, Ankara, Turkey.
Hakan
H
Yildiz
Departments of Gastroenterology, Ankara, Turkey.
Mustafa
M
Kaplan
Departments of Gastroenterology, Ankara, Turkey.
Muhammet Yener
MY
Akpinar
Departments of Gastroenterology, Ankara, Turkey.
Meral
M
Akdoğan
Departments of Gastroenterology, Ankara, Turkey.
Sabite
S
Kaçar
Departments of Gastroenterology, Ankara, Turkey.
Zeki Mesut Yalin
ZM
Kiliç
Departments of Gastroenterology, Ankara, Turkey.
Aydin Şeref
AŞ
Köksal
Departments of Gastroenterology, Ankara, Turkey.
Bülent
B
Ödemiş
Departments of Gastroenterology, Ankara, Turkey.
Ertuğrul
E
Kayaçetin
autoimmune hepatitis; clinical and histological features; drug-induced liver injury