Antituberculosis Drug-Induced Liver Injury with Autoimmune Features: Facing Diagnostic and Treatment Challenges
Table 1
Classification of drug-induced autoimmune liver disease.
AIH with DILI
Patients with known AIH AIH quiescent: the drug may be the trigger of a new bout AIH under IS or corticosteroids treatment: reactivation of a known AIH upon intro of a new drug (very difficult to demonstrate a causal relationship as it might be coincidental) Often advanced fibrosis on histology
DI-AIH
Patient with a low-grad disease not diagnosed before or predisposition to AIH Drug produce an immune reaction that lead to a chronic process: perpetuating the AIH Permanent need of IS Habitually typical HLA-DR associated
IM-DILI (Autoimmune hypersensitivity)
Fever, eosinophilia, lymphadenopathy, rush Indistinguishable from true AIH: mandatory IS treatment Frequently spontaneous remission after drug cessation Usually complete response to treatment and sustained remission without relapse It is the most frequent drug-induced immune process in the liver attributable to drugs
AIH: autoimmune hepatitis; DILI: drug-induced liver injury; IS: immunosuppressants; IM-DILI: immunomediated DILI; DIAILD: drug-induced autoimmune liver disease; HLA: human leukocyte antigen. Adapted from [3].