Drug Induced Liver Injury: A Descriptive Analyses of Histopathological Patterns and Clinical Outcomes

Abstract

Given the increased use of complementary and alternative medicine along with over-the-counter drugs, drug-induced liver injury (DILI) has become relatively common and a differential diagnosis for every other patient who presents with a deranged liver function test. As no specific markers or diagnostic tests exist to confirm DILI, it is a diagnosis of exclusion. Liver biopsy is a valuable tool for evaluating patients with clinical suspicion of DILI. However, there are limited published data describing histopathological diagnoses in DILI and their clinical outcomes in the Asian subcontinent. In this 2-year retrospective study conducted between January 2020 and December 2022, records of 34 DILI patients were evaluated. The histological patterns of injury and liver functions (total bilirubin and liver enzymes) were described and the corresponding clinical outcomes were assessed. All the included cases had elevated liver enzymes. The most common histopathological pattern in DILI was cholestatic hepatitis (n = 14, 41.0%). Eosinophilic prominence and inflammation around the portal tract were seen in majority of the cases (n = 25, 73.5%). A few cases had fibrosis as well (n = 12, 35.0%). The most common drug associated with liver injury was herbal/traditional medicines (n = 17, 50.0%). Certain histopathological “clues” can help the pathologist suspect a DILI diagnosis. The main findings associated with DILI are cholestatic hepatitis, lobular disarray, inflammation, and necrosis. Correlation with clinical history and biochemical parameters will help in clinching the diagnosis.