Drug-Induced Chronic Liver Disease

Diagnosis and treatment of autoimmune hepatitis

“…64 Furthermore, the patterns of indirect immunofluorescence (homogenous versus speckled) have had no clinical significance. 66 ANA can be found in primary biliary cirrhosis, 67,68 primary sclerosing cholangitis, 69,70 chronic viral hepatitis, 71,72 drug-related hepatitis, 73,74 nonalcoholic steatohepatitis, 47,75 and alcohol-induced liver disease, 76,77 and their expression can be variable in the same patient. 57 SMA are directed against actin and nonactin components, including tubulin, vimentin, desmin, and skeletin, and they are also standard markers of AIH.…”

Subdivisions of idiopathic autoimmune chronic active hepatitis

“…It has been further recognized that several therapeutic drugs, especially oxyphenisatin, methyldopa and nitrofurantoin, may cause an illness clinically and histologically indistinguishable from idiopathic autoimmune chronic active hepatitis (46)(47)(48)(49)(50)(51)(52)(53). Most patients with drug-related chronic hepatitis have been women with hyperglobulinemia; autoantibodies including LE cells, antismooth muscle antibodies and antinuclear antibodies; and chronic active hepatitis on liver biopsies.…”

“…Several patients with nitrofurantoin-induced chronic active hepatitis have had an HLA-B8 genotype, suggesting that there may be populations (especially of women) who are genetically predisposed to develop nitrofurantoin-induced chronic active hepatitis (54,55). The resolution or at least amelioration of the chronic active hepatitis which is generally observed following withdrawal of an inciting drug is the most convincing evidence the drug caused the liver injury (46)(47)(48)(49)(50)(51)(52)(53).…”

Chronic active hepatitis associated with etretinate therapy

“…Several drugs, the most notable being oxyphenasitin, alpha-methyldopa, and nitrofurantoin have been reported to cause liver disease that is clinically and histologically similar to chronic active hepatitis (CAH) (Maddrey & Boitnott, 1977). Although withdrawal of the offending drug has generally led to clinical improvement and regression of morphological findings, some patients have developed progressive hepatocellular injury and cirrhosis.…”