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].