Histologic Features Can Differentiate Drug-Induced Liver Injury from Autoimmune Hepatitis

The clinical scenario of a patient who presents with acute hepatitis on potentially hepatotoxic medications, with negative viral serologies but low-level autoimmune markers, can be challenging. The difficulty lies in determining whether the patient has drug-induced liver injury (DILI), for which there is no specific treatment, or autoimmune hepatitis (AIH), for which immunosuppressants are indicated. To date, histologic findings have generally not been helpful.

To explore possible differences in histologic profiles that could improve diagnostic accuracy, four experienced hepatopathologists conducted detailed, blinded reviews of 63 liver biopsies of clinically well-characterized cases of AIH and DILI. All were reviewed from clinical and histo…