drug-induced hepatitis

Drug-induced hepatitis, also known as drug-induced liver injury (DILI), is a rare condition caused by harmful (toxic) amounts of certain medicines, vitamins, herbal remedies, or food supplements.

• It involves inflammation of the liver, which can be acute or chronic in nature [9][10].
• The symptoms may include redness and swelling (inflammation) of the liver, nausea, vomiting, and malaise (feeling unwell) [7].
• In most cases, you may be taking a medicine for several months before it reaches a toxic level and affects your liver [10].
• The clinical symptoms, signs, and patterns of liver test abnormalities of DILI can mimic virtually any form of liver disease, from acute viral hepatitis to gall stone disease with biliary obstruction, acute fatty liver, and even chronic hepatitis and cirrhosis [12].

Risk factors for developing drug-induced liver injury (DILI) include:

• Age ≥ 18 years
• Obesity
• Pregnancy
• Concomitant alcohol consumption
• Certain genetic polymorphisms [15]

It's essential to note that DILI can be classified based on clinical presentation, mechanism of hepatotoxicity, or histological appearance from a liver biopsy. The true incidence is difficult to estimate, yet it has become the leading cause of acute liver failure in some regions [11].

References:

[7] S David · 2010 · Cited by 342 [9] [10] [11] [12] [15]

Common Signs and Symptoms of Drug-Induced Hepatitis

Drug-induced hepatitis, also known as drug-induced liver injury (DILI), can manifest in various ways, making it challenging to diagnose. However, there are some common signs and symptoms that may indicate the presence of this condition.

• Abdominal pain: A dull or sharp pain in the upper right quadrant of the abdomen is a frequent complaint among individuals with drug-induced hepatitis [3][6].
• Jaundice: Yellowing of the skin and whites of the eyes (jaundice) can occur due to the buildup of bilirubin in the blood [2][5][7].
• Dark urine: The urine may appear dark yellow or brown due to the presence of bilirubin [6][8].
• Fatigue and weakness: Many people experience tiredness, weakness, and a general feeling of being unwell [3][6].
• Fever: A fever can be present in some cases, although it's not always a reliable indicator [5][7].
• Nausea and vomiting: Some individuals may experience nausea and vomiting, especially if the liver is severely inflamed [4][8].

Other Possible Symptoms

In addition to these common signs and symptoms, other possible indicators of drug-induced hepatitis include:

• Loss of appetite
• Pale gray or clay-colored stools
• Itching (pruritus)

Important Note

It's essential to note that the symptoms of drug-induced hepatitis can be similar to those of other liver conditions, such as acute viral hepatitis. Therefore, a proper diagnosis by a healthcare professional is crucial to determine the underlying cause of these symptoms.

References:

[1] Not provided (no relevant information found)

[2] Context result 2

[3] Context result 3

[4] Context result 4

[5] Context result 5

[6] Context result 6

[7] Context result 7

[8] Context result 8

Diagnostic Tests for Drug-Induced Hepatitis

Drug-induced hepatitis, also known as drug-induced liver injury (DILI), can be challenging to diagnose due to its non-specific clinical presentation and laboratory findings. However, various diagnostic tests can help confirm the diagnosis.

• Liver Function Tests: Blood tests that measure liver enzymes, such as alanine transaminase (ALT) and aspartate transaminase (AST), are commonly used to assess liver function. Elevated levels of these enzymes indicate liver damage [5][9].
• Complete Blood Count: This test measures the number of red and white blood cells, which can be affected in cases of DILI [7].
• Coagulation Studies: These tests evaluate the blood's ability to clot, which can be impaired in cases of liver dysfunction [7].
• Electrolyte Panel: This test measures the levels of essential minerals, such as potassium and sodium, which can be disrupted in cases of DILI [7].

In addition to these laboratory tests, a physical examination and medical history are also crucial in diagnosing drug-induced hepatitis. Your healthcare provider may perform a physical exam to check for signs of liver damage, such as jaundice or abdominal tenderness.

It's essential to note that there is no specific diagnostic test for DILI, and the diagnosis is often made based on a combination of clinical presentation, laboratory findings, and medical history [4][10].

References:

[1] Andrade RJ, et al. EASL Clinical Practice Guidelines: Drug-induced liver injury. Journal of Hepatology. In press. April 24, 2019.

[2] Burt AD, et al, eds. Drugs and ...

[3] Development and validation of a clinical scale for the diagnosis of drug-induced hepatitis. Hepatology. 1997;26:664–669. doi: 10.1002/hep.510260319.

[4] There is no specific or diagnostic clinical presentation,

Treatment for Drug-Induced Hepatitis

The primary treatment for drug-induced hepatitis is to stop taking the medication that caused the liver damage [3][5]. This is often the only specific treatment needed, as most cases of liver damage caused by drugs can be reversed once the offending agent is discontinued.

In some cases, supportive care may be necessary to manage symptoms and complications such as jaundice, fatigue, and abdominal pain. However, there are no specific medications or treatments that target the underlying cause of drug-induced hepatitis [5].

Discontinuing the Offending Agent

Stopping the medication that caused the liver damage is crucial in treating drug-induced hepatitis. This can often be done on an outpatient basis, but in severe cases, hospitalization may be necessary to manage complications and provide supportive care.

Monitoring and Follow-Up

After discontinuing the offending agent, patients with drug-induced hepatitis should be closely monitored for signs of improvement or worsening liver damage. Regular follow-up appointments with a healthcare provider are essential to ensure that the liver is recovering and to address any concerns or complications that may arise [8].

Prevention

The best way to prevent drug-induced hepatitis is to avoid taking medications that can cause liver damage, especially in high doses or for extended periods. Patients should always follow their healthcare provider's instructions carefully and report any symptoms of liver damage, such as jaundice or abdominal pain, promptly.

References:

• [3] Many different drugs can cause drug-induced hepatitis.
• [5] There is no specific treatment for most cases of liver damage caused by taking a drug is to stop taking the drug that caused the ...
• [8] What's the treatment for toxic hepatitis? · Avoid taking certain medications or supplements that may cause liver toxicity.

The differential diagnosis of drug-induced hepatitis involves considering various conditions that can mimic or coexist with drug-induced liver injury (DILI). According to the provided context, some of these conditions include:

• Acute viral hepatitis
• Alcoholic liver disease
• Autoimmune hepatitis
• Budd-Chiari syndrome
• Cholangitis

These conditions should be considered in the differential diagnosis of DILI, as they can present with similar clinical symptoms and laboratory findings. In fact, it is mentioned that "The clinical symptoms, signs and patterns of liver test abnormalities of drug induced liver injury can mimic virtually any form of liver disease – from acute viral hepatitis to gall stone disease with biliary obstruction, acute fatty liver and even chronic hepatitis and cirrhosis" [10].

Additionally, the context notes that "Plasma cell infiltration in portal tracts, which is often prominent in autoimmune hepatitis, may be helpful for differential diagnosis in such cases" [12]. This suggests that careful evaluation of liver biopsy findings can aid in distinguishing between DILI and other conditions.

It's also worth noting that drug-induced autoimmune hepatitis (DIAIH) is a specific type of DILI that should be considered in the differential diagnosis. According to the context, "Drug‐induced autoimmune hepatitis (DIAIH) is an adverse effect associated with several drugs that usually occurs acutely, with variable latency, and it may potentially be mortal" [13].

Overall, a comprehensive approach to diagnosing DILI requires consideration of these various conditions and careful evaluation of clinical symptoms, laboratory findings, and liver biopsy results.

References: [10] The clinical symptoms, signs and patterns of liver test abnormalities of drug induced liver injury