[Drug-induced hepatitis: epidemiologic, clinical, diagnostic and physiopathologic aspects in 1995]

Drug-induced hepatotoxicity is a major cause of iatrogenic diseases. More than 900 compounds, including herbal medicines are involved and can reproduce the full spectrum of liver injuries. Acute hepatitis are the most frequently observed. Three types are described: acute hepatocellular hepatitis which are frequently similar to viral hepatitis, and can lead to fulminant liver failure and death within a few days, or, more insidiously, to cirrhosis; acute cholestatic hepatitis, which exhibits a better prognosis, may be misleading by mimicking biliary obstruction; mixed-pattern hepatitis, which associates features of hepatocellular and cholestatic hepatitis. Acute hepatitis generally exhibits no specific patterns. Then, the diagnosis is difficult and relies upon the elimination of other causes and a compatible or a suggestive time-relationship between drug ingestion and the onset of hepatitis as well as between drug withdrawal and recovery. Sometimes, drug hepatotoxicity is suggested by the association of hepatitis to hypersensitivity manifestations (hypereosinophilia), to some histopathological features (eosinophilic infiltration, microvesicular steatosis, giant hepatocytes) or, more uncommonly, to specific autoantibodies (anti-mitochondrial type 6, anti-LKM2, anti-LM antibodies). Cross hepatotoxicity may occur between drugs having related chemical structures.