Drug-Induced Liver Injury—Perspectives from Pathology

Purpose of Review: Drug-induced liver injury (DILI) may be caused by prescription or over-the-counter medications, herbals and nutritional supplements, or environmental agents. This review provides an overview of (1) pathogenetic mechanisms and risk factors, (2) biochemical classification, (3) diagnostic approach, (4) role of liver biopsy, and (5) narratives on commoner agents that cause DILI. Recent Findings: DILI is increasingly seen in contemporary practice due to increased usage of medications in general, introduction of newer agents for treatment of cancers and autoimmune diseases, and increasing consumption of herbals and nutritional supplements. Summary: Drug-induced liver injury is a significant cause of liver disease worldwide. No clinical, biochemical, or histological feature is specific for the diagnosis of DILI, which can mimic every pattern of liver injury and is in the differential diagnosis of every patient with liver disease. The diagnosis of DILI relies on (1) establishing a temporal association between clinical disease and initiation of the suspected drug, followed in the majority of cases by clinical improvement and disease resolution on its withdrawal and (2) exclusion of competing causes of liver injury. Herbals and nutritional supplements are particularly interesting as these are generally regarded as “safe, natural” compounds by an increasingly health-conscious population. Establishing a temporal relationship is often challenging as the patient may be taking multiple supplements simultaneously and is usually unclear about timing of initiation and withdrawal of the agents. Additionally, these agents change in potency and composition depending on the harvest conditions of the constituent botanicals. © 2018, Springer International Publishing AG, part of Springer Nature.