Table 2

Table 2 Overview of drug-induced liver injury patterns
Histological patternDifferential diagnosisCommon drugs involved
Acute hepatitis and cholestatic hepatitisViral hepatitis, autoimmune hepatitis, Wilson disease, idiopathicSee table 3
Acute liver failure
    Necrosis with marked inflammationAutoimmune hepatitis, viral hepatitis, Wilson diseaseIsoniazid, monoamine oxidase inhibitors, anticonvulsants (phenytoin, valproate), antimicrobials (sulfonamides, cotrimoxazole, ketoconazole)
    Necrosis with little or no inflammationHerpes simplex or adenoviral hepatitis, Wilson disease, malignant infiltrationAcetaminophen, cocaine, MDMA (ecstasy), carbon tetrachloride
    Microvesicular steatosis with little or no inflammationAcute alcohol intoxication, Reye syndrome, fatty liver of pregnancyTetracycline, nucleoside analogues
Chronic hepatitis
    Autoimmune marker-negativeAutoimmune hepatitis. chronic viral hepatitis, Wilson diseaseLisinopril, sulfonamides, trazodone, uracil, tegafur, tamoxifen, methotrexate
    Drug-induced autoimmune hepatitisAutoimmune hepatitisMinocycline, nitrofurantoin, methyldopa, clometacin
    Bland cholestasisSepsis, cardiac failure, shock, large duct obstruction, benign intrahepatic cholestasis, intrahepatic cholestasis of pregnancyAnabolic/androgenic steroids, oestrogenic steroids, NSAIDs (nimesulide, piroxicam)
    Cholestatic hepatitis (cholangiolitic or hypersensitivity cholestasis)Viral hepatitis, large duct obstructionChlorpromazine, clarithromycin
Granulomatous hepatitisInfections, sarcoidosis, primary biliary cirrhosis, talc, metal toxicityIsoniazid, interferon, phenytoin, allopurinol (also see box 2)
    Macrovesicular steatosisDiabetes, obesity, Wilson disease, hepatitis CAlcohol, steroids, total parenteral nutrition, gold, chlorinated hydrocarbons, chemotherapeutic agents (5-fluorouracil)
    Microvesicular steatosisFatty liver of pregnancy, carnitine deficiency, Reye syndromeCocaine, tetracycline, valproic acid, zidovudine
    Steatohepatitis(See macrovesicular steatosis differential)Amiodarone, chemotherapeutic agents (irinotecan), perhexiline
Vascular abnormalities
    Sinusoidal obstruction syndromeMyeloablation, venous outflow obstruction, right heart diseaseOxaliplatin, pyrrolizidine alkaloids, chemotherapy for ALL
  • ALL, acute lymphoblastic leukaemia; MDMA, 3,4-methylenedioxymethylamphetamine; NSAID, non-steroidal anti-inflammatory drug.