Clinicopathological Study of Autoimmune Hepatitis Cases That Were Difficult to Differentiate from Drug-Induced Liver Injury

2017 ◽  
Vol 35 (6) ◽  
pp. 506-514 ◽  
Author(s):  
Akemi Tsutsui ◽  
Kenichi Harada ◽  
Koichi Tsuneyama ◽  
Tomonori Senoh ◽  
Takuya Nagano ◽  
...  
Keyword(s):  
Liver Injury ◽  
Autoimmune Hepatitis ◽  
Scale Score ◽  
Plasma Cells ◽  
Final Diagnosis ◽  
Acute Onset ◽  
Pathological Findings ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Scale Scores

Aim: Acute-onset autoimmune hepatitis (AIH) histopathologically presents with features of acute hepatitis and lacks a specific diagnostic method. Also, AIH is often difficult to differentiate from drug-induced liver injury (DILI). We aimed to investigate the final clinical diagnosis of these cases, and compare the clinical, biochemical, and histological characteristics of AIH vs. DILI. Methods: We examined the Digestive Disease Week Japan 2004 (DDW-J) scale scores, AIH scores, clinical data, and pathological findings in 20 patients in whom it was difficult to differentiate autoimmune liver disease from DILI. Results: In cases with a DDW-J scale score of ≥5, there was a good correlation between the final diagnosis and DDW-J scale assessments, but in cases with a DDW-J scale score of ≦4 they did not correlate well. The scores for pathological findings, such as cobblestone hepatocellular change (p = 0.015), interface hepatitis (p = 0.012), and prominent plasma cells in portal areas (p = 0.011), were higher in the AIH group than in the DILI group. Conclusion: This study showed that DDW-J scale was useful for differentiating AIH from DILI in cases with a DDW-J scale score of ≧5. The histologic features of AIH were characterized by cobblestone hepatocellular change, interface hepatitis, and plasma cell infiltration of the portal region.

scholarly journals Menotrophin Induced Autoimmune Hepatitis

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Shurouq H. Alqrinawi ◽  
Nuralhuda Akbar ◽  
Hind AlFaddag ◽  
Shahrazad Akbar ◽  
Lujayn Akbar ◽  
...  
Keyword(s):  
Liver Injury ◽  
Autoimmune Hepatitis ◽  
Plasma Cells ◽  
Caucasian Woman ◽  
Drug Induced ◽  
Over The Counter ◽  
Drug Induced Liver Injury ◽  
First Case ◽  
Igg Level ◽  
New Onset

Menotrophin is a protein-based hormonal therapy. It is used as a fertility medication that is given as injection either subcutaneously or intramuscularly. Menotrophin has not been previously reported to cause drug-induced liver injury. Drug-induced liver injury (DILI) is commonly seen nowadays with the expansion of the drug industry. It is associated with prescribed medications, over the counter drugs, herbal and dietary supplements. We report the first case of Menotrophin-induced autoimmune hepatitis in a 26-year-old Caucasian woman who was diagnosed with primary infertility due to failure to conceive after five years of marriage. She had received several cycles of Menotrophin, then developed new onset jaundice and fatigue associated with increase in transaminases. She had normal baseline liver function and enzymes prior to receiving treatment with Menotrophin. Evaluation showed no evidence of viral hepatitis, metabolic, alcoholic or vascular causes of liver injury. Autoimmune screening was positive for antinuclear antibody (ANA) with titer of 1 : 640 fine speckled, immunoglobulin G (IgG) level was 1900 mg/dl. Antimitochondrial antibodies (AMA) and antismooth muscle antibodies were negative. Liver biopsy showed features of chronic hepatitis with interface hepatitis and prominence of plasma cells, which best reflects autoimmune hepatitis. Her liver enzymes and bilirubin completely normalized after discontinuation of further Menotrophin therapy and starting treatment with prednisolone and Azathioprine.

scholarly journals Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh

2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
Grace Guzman ◽  
Eric R. Kallwitz ◽  
Christina Wojewoda ◽  
Rohini Chennuri ◽  
Jamie Berkes ◽  
...  
Keyword(s):  
Liver Injury ◽  
Autoimmune Hepatitis ◽  
Plasma Cells ◽  
Hepatic Necrosis ◽  
Serum Markers ◽  
Black Cohosh ◽  
Herbal Supplement ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Immune Mediated

There are a growing number of cases detailing acute hepatic necrosis in patients taking black cohosh (Cimicifuga racemosa), an over-the-counter herbal supplement for management of menopausal symptoms. Our aim is to illustrate two cases of liver injury following the use of black cohosh characterized by histopathological features mimicking autoimmune hepatitis. Both patients reported black cohosh use for at least six months and had no evidence of another cause of liver disease. Their liver biopsies showed a component of centrilobular necrosis consistent with severe drug-induced liver injury. In addition, the biopsies showed characteristics of autoimmune-like liver injury with an interface hepatitis dominated by plasma cells. Although serum markers for autoimmune hepatitis were not particularly elevated, both patients responded to corticosteroids, supporting an immune-mediated component to the liver injury. Liver injury following the use of black cohosh should be included in the list of differential diagnoses for chronic hepatitis with features mimicking autoimmune hepatitis.

scholarly journals Drug induced liver injury and its relationship to autoimmune hepatitis

2011 ◽  
Vol 55 (4) ◽  
pp. 747-749 ◽  
Author(s):  
Christina Weiler-Normann ◽  
Christoph Schramm
Keyword(s):  
Liver Injury ◽  
Autoimmune Hepatitis ◽  
Drug Induced ◽  
Drug Induced Liver Injury

Seven cases of autoimmune hepatitis that developed after drug-induced liver injury

Hepatology ◽  
2011 ◽  
Vol 54 (5) ◽  
pp. 1892-1893 ◽  
Author(s):  
Kazushi Sugimoto ◽  
Takeshi Ito ◽  
Norihiko Yamamoto ◽  
Katsuya Shiraki
Keyword(s):  
Liver Injury ◽  
Autoimmune Hepatitis ◽  
Drug Induced ◽  
Drug Induced Liver Injury

Drug-Induced Liver Injury Mimicking Autoimmune Hepatitis After Treatment With TNF-alpha Inhibitor

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S1242
Author(s):  
Summer Lepley ◽  
Jared Pembrook ◽  
Kevin McGinn ◽  
Carmen Vesbianu
Keyword(s):  
Liver Injury ◽  
Autoimmune Hepatitis ◽  
Tnf Alpha ◽  
Drug Induced ◽  
Drug Induced Liver Injury

scholarly journals Comparison of Liver Biopsy Findings with the Digestive Disease Week Japan 2004 Scale for Diagnosis of Drug-Induced Liver Injury

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Akemi Tsutsui ◽  
Yasuni Nakanuma ◽  
Kouichi Takaguchi ◽  
Satoko Nakamura ◽  
Hiroshi Shibata ◽  
...  
Keyword(s):  
Liver Injury ◽  
Liver Biopsy ◽  
Digestive Disease ◽  
Drug Induced ◽  
Scale Evaluation ◽  
Drug Induced Liver Injury ◽  
Liver Injuries ◽  
Scale Scores ◽  
The Mean ◽  
Objective Tool

The liver biopsy remains a valuable tool in the diagnosis of drug-induced liver injury (DILI). The Digestive Disease Week Japan 2004 (DDW-J) scale proposed as an objective tool for the diagnosis of DILI has been widely used in Japan. So far, the histological features have not been compared with DDW-J scale in detail. Herein, we examined the correlation between liver biopsy findings and clinical features, particularly DDW-J scales. A total of 80 patients with liver injuries of unknown cause were enrolled. Based on the histological findings, these cases were categorized into 3 groups: A (DILI was strongly suspected), B (DILI was suspected), and C (DILI should be considered in the differential diagnosis). Histological groups and DDW-J scale were moderately correlated (κ=0.60). The mean total DDW-J scale scores were as follows: 4.89 for A, 3.26 for B, and 0.75 for C (p<0.05). While hepatocellular type was coincided in a majority of cases by histological and DDW-J scale evaluation, cholestatic type was not well coincided. In conclusion, biopsy findings and DDW-J scale were well correlated, and the hepatocellular type of liver injuries was well coincided by both evaluations, though there were several discrepant cases, particularly in cholestatic type.

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