Clinical features of drug-induced liver injury

Drugs (including herbal and dietary supplements) can cause acute or chronic liver injury. In many cases drug-induced liver injury is mild and reversible.

Drugs can cause hepatocellular damage, cholestatic disease, or a mixed pattern of liver injury. Hepatocellular damage is typically characterised by symptoms of malaise, abdominal pain and jaundice, and elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentrations. Cholestatic disease usually causes jaundice, itch, and elevated alkaline phosphatase (ALP) and gamma glutamyltransferase (GGT) concentrations.

Drug-induced autoimmune hepatitis, acute fatty liver, ductopenia, drug rash with eosinophilia and systemic symptoms (DRESS), secondary sclerosing cholangitis and granulomatous hepatitis have all been seen in cases of drug-induced liver injury. Occasionally, severe hepatocellular reactions can result in liver failure, death or urgent need for liver transplantation.