Recurrent Drug-Induced Liver Injury (DILI) with different drugs in the Spanish Registry: The dilemma of the relationship to autoimmune hepatitis

Clinical features and outcomes of patients with drug-induced autoimmune hepatitis: A retrospective cohort study

“…However, the key clinical question is the differential diagnosis between DI-AIH and DILI, especially in the presence of NOSAs positivity [17]. Up to now, differential diagnosis is challenging because of the lack of pathognomonic features and the resulting absence of enough specific diagnostic criteria.…”

“…Albeit DI-AIH is a rare condition, distinguishing this clinical entity among the group of DILI is essential for prognosis, and correct choice of treatment options [17]. In absence of consensus agreement on proper treatment, immunosuppression is still recommended for severe disease at onset and subsequent management should be based on individual clinical follow-up.…”

Drug-induced autoimmune liver disease: A diagnostic dilemma of an increasingly reported disease

“…This type of adverse drug reaction, which can be viewed as autoimmune hypersensitivity, is the most frequent drug-induced immune process in the liver that is attributable to drugs (see Table 1) [2,12] . A second DILI episode (recurrent DILI) involving a different drug is a rare event, but if it happens, AIH or AIH-like DILI is frequent, and reported in up to 40% of cases in the series published from the Spanish DILI Registry [20] . Differentiating IM-DILI from DI-AIH in these cases is very difficult as the clinical presentation may be the same [20] .…”

Hepatotoxicity in 2011: advancing resolutely

“…On the other hand, in the multivariate analysis of factors with a potential impact on serious hepatotoxicity outcomes in DILIN, alcohol use during the previous 12 months behaved as a protective factor (OR = 0.33) (5). Autoimmune hepatitis represents a particularly difficult issue when it comes to differentiate it from idiosyncratic hepatotoxicity, since both conditions lack specific markers and some drugs induce autoimmune hepatitis-like syndromes (minocycline, nitrofurantoin, and methyldopa) (47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59). Other drugs such as interferon alfa or anti-TNF-alfa antibodies may unmask latent autoimmune hepatitis.…”

“…Other drugs such as interferon alfa or anti-TNF-alfa antibodies may unmask latent autoimmune hepatitis. In fact, the development of hepatitis with autoimmunity phenomena during drug therapy poses the dilemma of whether it is a true autoimmune hepatitis, and onset coincided with the taking of an unrelated drug, or the drug gave rise, either directly or through lowgrade liver injury, to autoimmune hepatitis in a genetically predisposed patients (50). Selected drugs, even in the absence of liver damage, may favor the development of antibodies.…”