J Korean Med Sci.  2015 Dec;30(12):1815-1820. 10.3346/jkms.2015.30.12.1815.

Clinical Features of Drug-induced Liver Injury According to Etiology

• Lee BM
• Lee WC
• Jang JY
• Ahn P
• Kim JN
• Jeong SW
• Park EJ
• Lee SH
• Kim SG
• Cha SW
• Kim YS
• Cho YD
• Kim HS
• Kim BS

• KMID: 2359966
• DOI: http://doi.org/10.3346/jkms.2015.30.12.1815

Abstract

Drug-induced liver injury (DILI) is an increasingly common cause of acute hepatitis. We examined clinical features and types of liver injury of 65 affected patients who underwent liver biopsy according DILI etiology. The major causes of DILI were the use of herbal medications (43.2%), prescribed medications (21.6%), and traditional therapeutic preparations and dietary supplements (35%). DILI from herbal medications, traditional therapeutic preparations, and dietary supplements was associated with higher elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than was DILI from prescription medications. The types of liver injury based on the R ratio were hepatocellular (67.7%), mixed (10.8%), and cholestatic (21.5%). Herbal medications and traditional therapeutic preparations were more commonly associated with hepatocellular liver injury than were prescription medications (P = 0.002). Herbal medications and traditional therapeutic preparations induce more hepatocellular DILI and increased elevations in AST and ALT than prescribed medications.

Keyword

Drug-induced Liver Injury; Hepatotoxicity; Etiology; Plants, Medicinal; Traditional Therapy; Prescribed Medicines

MeSH Terms

Adult
Alanine Transaminase/blood
Aspartate Aminotransferases/blood
Dietary Supplements/adverse effects
Drug-Induced Liver Injury/enzymology/*etiology/pathology
Female
Humans
Male
Middle Aged
Phytotherapy/adverse effects
Plant Preparations/adverse effects
Prescription Drugs/adverse effects
Republic of Korea
Retrospective Studies
Alanine Transaminase
Aspartate Aminotransferases
Plant Preparations
Prescription Drugs

Figure

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  Fig. 1 Flow chart of the enrolled patients.

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  Fig. 2 Main pathologic findings of drug induced liver injury. (A) There are several centrilobular confluent necrosis at the acinar zone III with bridging necrosis connected to the adjacent vascular structure (H&E stain, × 40). (B) Trichrome stain showed enlarged portal tract with minimal portal fibrosis (Trichrome stain, × 40). (C) The necrotic acinar zone III areas are mostly infiltrated by lipofusin pigment laden histiocytes. There is also surrounding chronic inflammatory cell infiltration (H&E stain, × 100). (D) Focal necrosis and acidophilic body formation of the hepatocytes with Kupffer cell hyperplasia are also present (H&E stain, × 200).

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