Published in:
01-09-2018 | Drug-Induced Liver Injury (NP Chalasani and MS Ghabril, Section Editors)
Uncommon Presentations of Idiosyncratic Drug-Induced Liver Injury
Published in: Current Hepatology Reports | Issue 3/2018
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Purpose of Review
Idiosyncratic drug-induced liver injury (DILI) typically presents acutely with liver test abnormalities, sometimes with associated symptoms of abdominal pain, nausea, vomiting, jaundice, fevers, and rash. Histologic abnormalities in such cases of DILI typically range from lobular or portal hepatitis to hepatocyte necrosis. However, sometimes the drug-related liver injuries present with clinical and/or histological features atypical of garden variety DILI and they may be related to uncommon mechanisms of injury, histologic features, or clinical presentation.
Recent Findings
Multiple agents or classes of agents can result in uncommon forms of liver injury that are phenotypically unique and differ from commonly recognized acute DILI. These include unusual presentations of drugs commonly associated with typical acute DILI, such as drug-induced autoimmune hepatitis. Atypical DILI also includes histologically atypical manifestations of DILI, such as nodular regenerative hyperplasia, sinusoidal obstruction syndrome, granulomatous hepatitis, and steatosis/steatohepatitis.
Summary
Atypical DILI encompasses recognized patterns of injury associated with specific agents or drug classes. These can manifest by atypical biochemical, clinical, and histopathological signatures. An understanding of these types of liver injury is important for the timely recognition of such atypical DILI.