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Treatment of Idiosyncratic Drug-Induced Liver Injury Using Steroids
Abstract
Idiosyncratic drug-induced liver injury (DILI), when severe, can be associated with significant morbidity and mortality. Currently, there are no specific therapies for DILI, apart from corticosteroids for drug-induced autoimmune hepatitis caused by drugs such as nitrofurantoin or minocycline. We present 2 cases of DILI that improved with corticosteroid therapy despite the lack of autoimmune features by serology or histology. The current observations make a strong case for formally testing corticosteroids in a controlled trial in patients with suspected DILI.
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![Figure 1. (A) Liver test trends in relation to exposure to the implicated drug (imatinib) and initiation of steroid. The rechallenge with imatinib was associated with a repeat increase in alanine aminotransferase and total bilirubin levels. (B) Perivenulitis with necrosis and an inflammatory infiltrate of lymphocytes and pigmented macrophages (hematoxylin and eosin [H&E] 10×). (C) Moderate portal inflammation consisting mainly of lymphocytes with a few intermingled eosinophils. Mild interface hepatitis, not indicative of autoimmune hepatitis, is present. Bile ducts are present and show minimal epithelial damage (H&E 100×). ALT, alanine transferase; ALP, alkaline phosphatase.](/paper-figures/b307ad38a1fd41459eaa37677fe7f657/treatment-of-idiosyncratic-drug-induced-liver-injury-using-steroids-figure-1.jpg)
![Figure 2. (A) Liver test trends in relation to exposure to cephalexin and initiation of budesonide 142 days after the onset of liver injury. The timing of the liver biopsy indicated on the x axis. (B) Portal tract with mild inflammatory infiltrate of lymphocytes and eosinophils with marked biliary epithelial damage. There is no interface hepatitis (hematoxylin and eosin [H&E] 10×). (C) Portal tract with no inflammation. Bile ducts are present (H&E 100×). ALT, alanine transferase; ALP, alkaline phosphatase.](/paper-figures/8db88b36e1d547b087cfe5e5a3a71754/treatment-of-idiosyncratic-drug-induced-liver-injury-using-steroids-figure-2.jpg)
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“While some studies have suggested that corticosteroids ameliorate liver injury [187][188][189][190][191], others have suggested that they increase adverse events without significant benefits [192,193].”
From Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update (2024) · cites this paper as [188]
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Research works printed but not linked: 1
- Chalasani, 2008, Characteristics of patients with idiosyncratic drug induced liver injury (DILI) who receive systemic corticosteroids: Initial results from the U.S. DILI network prospective study, Am J Gastroenterol, 103, S144, 10.14309/00000434-200809001-00375 · DOI
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ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury
Chalasani, N. P., Hayashi, P. H., Bonkovsky, H. L., Navarro, V. J., Lee, W. M., & Fontana, R. J. (2014) · American Journal of Gastroenterology · doi:10.1038/ajg.2014.131 · Cited by 860
Self-citationACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury
Chalasani, N. P., Maddur, H., Russo, M. W., Wong, R. J., Reddy, K. R., & on behalf of the Practice Parameters Committee of the American College of Gastroenterology (2021) · American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001259 · Cited by 430
Self-citationChinese guideline for the diagnosis and treatment of drug-induced liver injury: an update
Mao, Y., Ma, S., Liu, C., Liu, X., Su, M., Li, D., Li, Y., Chen, G., Chen, J., Chen, J., et al. (2024) · Hepatology International · doi:10.1007/s12072-023-10633-7 · Cited by 62
Metadata
- Authors
- Sundaram, S., Vuppalanchi, R., Saxena, R., & Chalasani, N.
- Venue
- ACG Case Reports Journal
- Published
- 2020-02
- Volume
- 7
- Issue
- 2
- Pages
- e00319
- ISSN
- 2326-3253
- PMC
- PMC7145177
- Cited by
- 7
- References
- 0
- Language
- en
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