Table 2 Overview of drug-induced liver injury patterns
| Histological pattern | Differential diagnosis | Common drugs involved |
| Acute hepatitis and cholestatic hepatitis | Viral hepatitis, autoimmune hepatitis, Wilson disease, idiopathic | See table 3 |
| Acute liver failure | ||
| Necrosis with marked inflammation | Autoimmune hepatitis, viral hepatitis, Wilson disease | Isoniazid, monoamine oxidase inhibitors, anticonvulsants (phenytoin, valproate), antimicrobials (sulfonamides, cotrimoxazole, ketoconazole) |
| Necrosis with little or no inflammation | Herpes simplex or adenoviral hepatitis, Wilson disease, malignant infiltration | Acetaminophen, cocaine, MDMA (ecstasy), carbon tetrachloride |
| Microvesicular steatosis with little or no inflammation | Acute alcohol intoxication, Reye syndrome, fatty liver of pregnancy | Tetracycline, nucleoside analogues |
| Chronic hepatitis | ||
| Autoimmune marker-negative | Autoimmune hepatitis. chronic viral hepatitis, Wilson disease | Lisinopril, sulfonamides, trazodone, uracil, tegafur, tamoxifen, methotrexate |
| Drug-induced autoimmune hepatitis | Autoimmune hepatitis | Minocycline, nitrofurantoin, methyldopa, clometacin |
| Cholestasis | ||
| Bland cholestasis | Sepsis, cardiac failure, shock, large duct obstruction, benign intrahepatic cholestasis, intrahepatic cholestasis of pregnancy | Anabolic/androgenic steroids, oestrogenic steroids, NSAIDs (nimesulide, piroxicam) |
| Cholestatic hepatitis (cholangiolitic or hypersensitivity cholestasis) | Viral hepatitis, large duct obstruction | Chlorpromazine, clarithromycin |
| Granulomatous hepatitis | Infections, sarcoidosis, primary biliary cirrhosis, talc, metal toxicity | Isoniazid, interferon, phenytoin, allopurinol (also see box 2) |
| Steatosis/steatohepatitis | ||
| Macrovesicular steatosis | Diabetes, obesity, Wilson disease, hepatitis C | Alcohol, steroids, total parenteral nutrition, gold, chlorinated hydrocarbons, chemotherapeutic agents (5-fluorouracil) |
| Microvesicular steatosis | Fatty liver of pregnancy, carnitine deficiency, Reye syndrome | Cocaine, tetracycline, valproic acid, zidovudine |
| Steatohepatitis | (See macrovesicular steatosis differential) | Amiodarone, chemotherapeutic agents (irinotecan), perhexiline |
| Vascular abnormalities | ||
| Sinusoidal obstruction syndrome | Myeloablation, venous outflow obstruction, right heart disease | Oxaliplatin, pyrrolizidine alkaloids, chemotherapy for ALL |
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ALL, acute lymphoblastic leukaemia; MDMA, 3,4-methylenedioxymethylamphetamine; NSAID, non-steroidal anti-inflammatory drug.
