Drug-induced liver injury with autoimmune features

Semin Liver Dis. 2014 May;34(2):194-204. doi: 10.1055/s-0034-1375959. Epub 2014 May 31.


Drug-induced liver injury (DILI) with features of autoimmunity (AI) represents an important category of hepatotoxicity due to medication exposure. Drugs repeatedly associated with AI-DILI include diclofenac, α-methyl DOPA, hydralazine, nitrofurantoin, minocycline, and more recently statins and anti-TNF-α agents. Usually, symptoms of acute liver injury occur within a few months after initiation of a culprit medication, but a longer latency period is possible. Like idiopathic autoimmune hepatitis, circulating autoantibodies and a hypergammaglobulinemia are frequently present in sera from patients with AI-DILI. If performed, a liver biopsy should demonstrate interface hepatitis with a prominent plasma cell infiltrate. The severity of AI-DILI is variable, but a complete resolution after withdrawal of the offending medication is the expectation. A response to corticosteroid therapy supports the diagnosis, whereas a lack of recurrence of symptoms or signs following corticosteroid cessation distinguishes AI-DILI from idiopathic autoimmune hepatitis.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adult
  • Anti-Bacterial Agents / adverse effects
  • Anti-Infective Agents, Urinary / adverse effects
  • Antihypertensive Agents / adverse effects
  • Autoantibodies / blood*
  • Autoimmunity*
  • Chemical and Drug Induced Liver Injury / complications
  • Chemical and Drug Induced Liver Injury / diagnosis*
  • Chemical and Drug Induced Liver Injury / genetics
  • Chemical and Drug Induced Liver Injury / immunology*
  • Chemical and Drug Induced Liver Injury / metabolism
  • Cytokines / genetics
  • Diagnosis, Differential
  • Drug Hypersensitivity / diagnosis
  • Drug Hypersensitivity / immunology
  • Female
  • HLA Antigens / genetics
  • Hepatitis, Autoimmune / blood
  • Hepatitis, Autoimmune / diagnosis*
  • Humans
  • Hydralazine / adverse effects
  • Hypergammaglobulinemia / etiology
  • Liver / pathology
  • Liver Function Tests
  • Male
  • Methyldopa / adverse effects
  • Minocycline / adverse effects
  • Nitrofurantoin / adverse effects
  • Time Factors
  • Young Adult


  • Anti-Bacterial Agents
  • Anti-Infective Agents, Urinary
  • Antihypertensive Agents
  • Autoantibodies
  • Cytokines
  • HLA Antigens
  • Hydralazine
  • Methyldopa
  • Nitrofurantoin
  • Minocycline