The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug‐induced liver injury

@article{Suzuki2011TheUO,
  title={The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug‐induced liver injury},
  author={Ayako Suzuki and Elizabeth M. Brunt and David E. Kleiner and Rosa Miquel and Thomas C Smyrk and Ra{\'u}l J Andrade and Mar{\'i}a Isabel Lucena and Agust{\'i}n Castiella and Keith D. Lindor and Einar S Bj{\"o}rnsson},
  journal={Hepatology},
  year={2011},
  volume={54}
}
UNLABELLED Distinguishing drug-induced liver injury (DILI) from idiopathic autoimmune hepatitis (AIH) can be challenging. [...] Key Method Biopsies from patients with clinically well-characterized DILI [n = 35, including 19 hepatocellular injury (HC) and 16 cholestatic/mixed injury (CS)] and AIH (n = 28) were evaluated for Ishak scores, prominent inflammatory cell types in portal and intra-acinar areas, the presence or absence of emperipolesis, rosette formation, and cholestasis in a blinded fashion by four…Expand
Clinicopathological Study of Autoimmune Hepatitis Cases That Were Difficult to Differentiate from Drug-Induced Liver Injury
TLDR
It was showed that DDW-J scale was useful for differentiating AIH from DILI in cases with a DDW -J scale score of ≧5, and the histologic features of AIH were characterized by cobblestone hepatocellular change, interface hepatitis, and plasma cell infiltration of the portal region. Expand
Liver Fibrosis Helps to Distinguish Autoimmune Hepatitis from DILI with Autoimmune Features: A Review of Twenty Cases
TLDR
Although there is no histologic feature pathognomonic for AI-DILI or AIH, advanced stages of liver fibrosis can be used to support the diagnosis of AIH in some cases. Expand
Hepatic Histological Findings in Suspected Drug-Induced Liver Injury: Systematic Evaluation and Clinical Associations
TLDR
An approach for evaluating liver histology in DILI is described and numerous associations between pathological findings and clinical presentations are demonstrated that may serve as a foundation for future studies correlating D ILI pathology with its causality and outcome. Expand
The clinical features of drug-induced liver injury observed through liver biopsy: focus on relevancy to autoimmune hepatitis
TLDR
Accurate diagnosis is necessary for patients with a history of medication and visits for liver-function abnormalities; in particular, the possibility of autoimmune hepatitis (AIH) should be considered. Expand
Features of Autoimmune Hepatitis in Patients With Drug‐induced Liver Injury
  • Y. D. de Boer, A. Kosinski, +5 authors J. Hoofnagle
  • Medicine
  • Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
  • 2017
TLDR
It is found that most cases of DILI attributed to nitrofurantoin or minocycline and about half of cases that were due to methyldopa and hydralazine have a phenotype of autoimmunity similar to AIH. Expand
Flare of Autoimmune Hepatitis Causing Acute on Chronic Liver Failure: Diagnosis and Response to Corticosteroid Therapy
TLDR
A low threshold for liver biopsy is needed to confirm the diagnosis of AIH presenting as ACLF as nearly half the patients are seronegative; early stratification to steroid therapy or liver transplantation would reduce ICU stay and improve outcomes. Expand
ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury.
TLDR
Patients with DILI who develop progressive jaundice with or without coagulopathy should be referred to a tertiary care center for specialized care, including consideration for potential liver transplantation. Expand
Role of Histopathology in Autoimmune Hepatitis
TLDR
This review focuses on the role of histopathology in AIH and highlights the contribution of histological interpretation to the diagnosis of AIH, differential diagnosis from other entities, recognition of concurrent liver disease, and identification of the so-called overlap or variant syndromes. Expand
Comparative analysis of portal hepatic infiltrating leucocytes in acute drug‐induced liver injury, idiopathic autoimmune and viral hepatitis
TLDR
Liver biopsies from subjects with DILI were characterized by low counts of mature B cells and NK cells in portal triads in contrast to VH, and Plasma cells were associated most strongly with AIH and less so with AID, but were uncommon in IAD. Expand
Liver biopsy is a superior diagnostic method in some patients showing the typical laboratory features of autoimmune hepatitis.
TLDR
Although histological findings have little impact on patients' management and outcomes, for a definitive diagnosis of AIH, liver biopsy is essential and should be performed in all patients in whom it is suitable and not contraindicated. Expand
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