The clinical features of drug-induced liver injury observed through liver biopsy: focus on relevancy to autoimmune hepatitis.
10.3350/cmh.2012.18.2.213
- Author:
Hye Young JU
1
;
Jae Young JANG
;
Soung Won JEONG
;
Sung Ae WOO
;
Min Gyu KONG
;
Hee Yoon JANG
;
Sae Hwan LEE
;
Sang Gyune KIM
;
Sang Woo CHA
;
Young Seok KIM
;
Young Deok CHO
;
So Young JIN
;
Hong Soo KIM
;
Boo Sung KIM
Author Information
1. Institute for Digestive Research, Digestive Disease Center, Depertment of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea. jyjang@schmc.ac.kr
- Publication Type:Original Article
- Keywords:
Drug-induced liver injury;
Autoimmune hepatitis;
Diagnosis
- MeSH:
Adult;
Alanine Transaminase/blood;
Antibodies, Antinuclear/blood;
Aspartate Aminotransferases/blood;
Biopsy;
Drug-Induced Liver Injury/*diagnosis/pathology;
Female;
Globulins/analysis;
Hepatitis, Autoimmune/*diagnosis/pathology;
Herbal Medicine;
Humans;
Jaundice/etiology;
Male;
Middle Aged;
Prothrombin Time
- From:Clinical and Molecular Hepatology
2012;18(2):213-218
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: 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 gamma-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.
