When Is Suspected Drug-Induced Liver Injury (DILI) Not DILI? An Analysis of Unlikely Cases From the Drug-Induced Liver Injury Network

Am J Gastroenterol. 2023 Dec 1;118(12):2301-2304. doi: 10.14309/ajg.0000000000002370. Epub 2023 Jun 14.

Abstract

Introduction: Diagnosis of drug-induced liver injury (DILI) is difficult. We reviewed cases in the DILI Network prospective study that were adjudicated to have liver injury due to other causes to discover pearls for improved diagnostic accuracy.

Methods: Cases were adjudicated by expert opinion and scored from 1 (definite DILI) to 5 (unlikely DILI). Confirmed cases (1-3) were compared with unlikely cases (5).

Results: One hundred thirty-four of the 1,916 cases (7%) were unlikely DILI. Alternative diagnoses were autoimmune hepatitis (20%), hepatitis C (20%), bile duct pathology (13%), and hepatitis E (8%).

Discussion: Thorough evaluation, including follow-up, is essential to minimize incorrect diagnosis of idiosyncratic DILI.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Causality
  • Chemical and Drug Induced Liver Injury* / diagnosis
  • Chemical and Drug Induced Liver Injury* / epidemiology
  • Chemical and Drug Induced Liver Injury* / etiology
  • Hepatitis C* / pathology
  • Humans
  • Liver / pathology
  • Prospective Studies