Drug-induced autoimmune hepatitis: A minireview

Area of Science:

• Hepatology
• Immunology
• Pharmacology

Background:

• Drug-induced autoimmune hepatitis (DIAIH) is a significant cause of drug-induced liver injury (DILI).
• DIAIH shares clinical and histological features with idiopathic autoimmune hepatitis (AIH), complicating diagnosis.
• Various drug classes, including antimicrobials, NSAIDs, statins, and anti-TNF agents, are implicated in DIAIH.

Purpose of the Study:

• To highlight the diagnostic challenges and clinical features of DIAIH.
• To present two cases of DIAIH secondary to Sorafenib and Atorvastatin.
• To review the literature on DIAIH and emphasize early identification and management strategies.

Main Methods:

• Case report presentation of two patients with DIAIH.
• Literature review of drug-induced autoimmune hepatitis.
• Analysis of clinical presentation, diagnostic workup, and treatment outcomes.

Main Results:

• The clinical presentation of DIAIH can be indistinguishable from AIH, including positive autoantibodies and elevated immunoglobulin G.
• Liver biopsy may be necessary, with advanced fibrosis favoring idiopathic AIH.
• Cessation of the suspected drug is key, with spontaneous resolution and lack of relapse after steroid taper supporting DIAIH.

Conclusions:

• Early recognition of DIAIH based on drug history and clinical course is vital.
• Prompt drug withdrawal and appropriate management, including corticosteroids if needed, lead to favorable outcomes.
• Distinguishing DIAIH from AIH is critical to avoid unnecessary long-term immunosuppression.