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Updated: Jul 18, 2026
Immuno-fluorescence Assay of Leptospiral Surface-exposed Proteins
Published on: July 1, 2011
LKM Immunofluorescence Is Associated with DILI, Especially after Metamizole Intake
Kilian Bock1, Bastian Engel2, Elmar Jaeckel3
1Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover, Germany, bock.kilian@mh-hannover.de.
Introduction:
Drug-induced liver injury (DILI) is a rare but potentially serious clinical condition. One phenotype of DILI is termed drug-induced autoimmune like hepatitis (DI-ALH) that presents with laboratory and histological features indistinguishable from autoimmune hepatitis. Liver kidney microsomal antibodies (LKM-antibodies) are common in the diagnosis of AIH but were also described to be associated with halothane-induced DILI. Also, the antigens of anti-LKM-1 and anti-LKM-2 belong to the cytochrome P450 enzyme family that is involved in the metabolism of various drugs. Therefore, we aimed to study the impact of LKM-antibodies in the diagnostic work-up of suspected DILI in a large cohort of patients with liver injury in a tertiary care centre.
Methods:
We screened a large single centre hospital database and retrospectively identified 63,300 cases with liver injury as defined: AST or ALT >3 upper limit of normal (ULN) or AP or TBI >2 ULN. Of those, 82 cases with LKM immunofluorescence positivity (titre ≥1: 160) were identified, of which 64 patients fulfilled the inclusion criteria for this study.
Results:
Positive LKM immunofluorescence was associated with drug-induced autoimmune-like hepatitis (DI-ALH). Metamizole association was identified in half of the patients (n = 33, 52%). Eight patients with metamizole associated DI-ALHs required liver transplantation and 1 patient died.
Conclusion:
DI-ALH, especially after metamizole administration, can be a reason for a positivity in LKM immunofluorescence tests. Metamizole DI-ALH has a high liver-related mortality.
