Drug induced liver injury liver biopsy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]

Overview

There are no specific liver biopsy findings diagnostic of drug induced injury, but there are several broad histological patterns that reflect the type of injury caused by the inciting drug. Moreover, the same medication can induce a different pattern of liver injury depending on the patient.

Liver Biopsy

The most common histological patterns seen in the drug induced liver injury network are as follows:

Acute hepatitis (21%)
Chronic hepatitis (14%)
Cholestatic hepatitis (29%)
Acute cholestasis (9%)
Chronic cholestasis (10%)

On biopsy, drug induced liver injury is characterized by hepatocellular injury and severe inflammation, necrosis, hemorrhage, and rosette formation. Patients with cholestatic injury tend to have more bile plugs and duct paucity. Certain findings on biopsy are predictive of severe and even fatal hepatic injury, including higher degrees of necrosis, microvesicular steatosis, [[fibrosis], and duct reactions. In contrast, eosinophils and granulomas are associated with milder injury.^[1]

References

↑ Kleiner DE, Chalasani NP, Lee WM, Fontana RJ, Bonkovsky HL, Watkins PB; et al. (2014). “Hepatic histological findings in suspected drug-induced liver injury: systematic evaluation and clinical associations”. Hepatology. 59 (2): 661–70. doi:10.1002/hep.26709. PMC 3946736. PMID 24037963.

[pmid24037963-1] Kleiner DE, Chalasani NP, Lee WM, Fontana RJ, Bonkovsky HL, Watkins PB; et al. (2014). “Hepatic histological findings in suspected drug-induced liver injury: systematic evaluation and clinical associations”. Hepatology. 59 (2): 661–70. doi:10.1002/hep.26709. PMC 3946736. PMID 24037963.

[1]