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Updated: Jun 10, 2026

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
11:06

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Published on: January 31, 2022

Drug Induced Liver Injury in Children: Practical Considerations for Pathologists

Kalyani R Patel1, Juan Putra2

  • 1Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Pediatric and Developmental Pathology : the Official Journal of the Society for Pediatric Pathology and the Paediatric Pathology Society
|June 9, 2026
PubMed

Insights

Diagnosing drug-induced liver injury (DILI) in children is challenging. This review covers DILI patterns, common drug culprits like antimicrobials, and liver biopsy interpretation for accurate diagnosis.

Area of Science:

  • Pediatric Hepatology
  • Toxicology
  • Gastroenterology

Background:

  • Drug-induced liver injury (DILI) in children presents a complex diagnostic challenge due to diverse clinical and histological manifestations.
  • DILI is categorized by pathogenesis into idiosyncratic, intrinsic (direct), or indirect types.
  • Antimicrobials and antiepileptic drugs are frequently implicated agents in the United States.

Purpose of the Study:

  • To review the primary morphologic patterns of pediatric DILI.
  • To identify commonly associated causative agents.
  • To provide practical guidance for interpreting liver biopsies in DILI cases.

Main Methods:

  • This is a review article, synthesizing existing literature on pediatric DILI.
  • Focuses on clinicopathologic correlation for diagnosis and causality assessment.
  • Highlights the role of liver biopsy in characterizing injury, assessing severity, and ruling out differential diagnoses.

Main Results:

  • Histologic features in pediatric DILI are often nonspecific, necessitating clinicopathologic correlation.
  • Liver biopsy, while not always essential, aids in characterizing injury patterns and severity.
  • Commonly implicated agents include antimicrobials and antiepileptic medications.

Conclusions:

  • Accurate diagnosis of pediatric DILI requires careful clinicopathologic correlation.
  • Understanding morphologic patterns and associated agents is crucial for effective management.
  • Liver biopsy interpretation is a key component in diagnosing and managing DILI in children.
Keywords:
Lafora-like inclusionsacute cholestasisdrugshepatitisvanishing bile duct syndrome

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