A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis—Can We Draw a Line?
Idiosyncratic drug-induced liver injury (DILI) is an unpredictable reaction of individuals exposed to a certain drug, and drug-induced autoimmune hepatitis (DIAIH) presents a DILI phenotype that mimics idiopathic autoimmune hepatitis (AIH) when considering the clinical, biochemical, serological and...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-11-01
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| Series: | Clinics and Practice |
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| Online Access: | https://www.mdpi.com/2039-7283/13/6/125 |
| _version_ | 1797381561399640064 |
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| author | Dorotea Božić Ante Tonkić Katarina Vukojevic Maja Radman |
| author_facet | Dorotea Božić Ante Tonkić Katarina Vukojevic Maja Radman |
| author_sort | Dorotea Božić |
| collection | DOAJ |
| description | Idiosyncratic drug-induced liver injury (DILI) is an unpredictable reaction of individuals exposed to a certain drug, and drug-induced autoimmune hepatitis (DIAIH) presents a DILI phenotype that mimics idiopathic autoimmune hepatitis (AIH) when considering the clinical, biochemical, serological and histological parameters. We present a case report of a 48-year-old male who was hospitalized due to severe hepatocellular liver injury two months after self-treatment with a muscle-building dietary supplement based on arginine-alpha-ketoglutarate, L-citrulline, L tyrosine, creatine malate and beet extract. His immunology panel was positive with increased IgG levels, and radiologic methods showed no signs of chronic liver disease. He underwent corticosteroid treatment with adequate response. After therapy withdrawal, a clinical relapse occurred. Seven months after the initial presentation, liver MR suggested initial cirrhotic changes in the right liver lobe. A liver biopsy revealed abundant lymphoplasmacytic infiltrate with piecemeal necrosis and grade 2 fibrosis. He responded well to the corticosteroid treatment again, and was further treated with low-dose prednisone without additional relapses. Several years later, further management confirmed the presence of liver cirrhosis with no histological or biochemical signs of disease activity. DIAIH is a DILI phenotype that is difficult to distinguish from idiopathic AIH despite a wide armamentarium of diagnostic methods. It should always be considered among the differential diagnoses in patients presenting with hepatocellular liver injury. |
| first_indexed | 2024-03-08T20:54:15Z |
| format | Article |
| id | doaj.art-f80737212b1b42ebabfeec3bafe4c8f6 |
| institution | Directory Open Access Journal |
| issn | 2039-7283 |
| language | English |
| last_indexed | 2024-03-08T20:54:15Z |
| publishDate | 2023-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Clinics and Practice |
| spelling | doaj.art-f80737212b1b42ebabfeec3bafe4c8f62023-12-22T14:00:59ZengMDPI AGClinics and Practice2039-72832023-11-011361393139910.3390/clinpract13060125A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis—Can We Draw a Line?Dorotea Božić0Ante Tonkić1Katarina Vukojevic2Maja Radman3Department of Gastroenterology, University Hospital of Split, Spinčićeva 1, 21000 Split, CroatiaDepartment of Endocrinology, University Hospital of Split, Spinčićeva 1, 21000 Split, CroatiaDepartment of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, CroatiaDepartment of Endocrinology, University Hospital of Split, Spinčićeva 1, 21000 Split, CroatiaIdiosyncratic drug-induced liver injury (DILI) is an unpredictable reaction of individuals exposed to a certain drug, and drug-induced autoimmune hepatitis (DIAIH) presents a DILI phenotype that mimics idiopathic autoimmune hepatitis (AIH) when considering the clinical, biochemical, serological and histological parameters. We present a case report of a 48-year-old male who was hospitalized due to severe hepatocellular liver injury two months after self-treatment with a muscle-building dietary supplement based on arginine-alpha-ketoglutarate, L-citrulline, L tyrosine, creatine malate and beet extract. His immunology panel was positive with increased IgG levels, and radiologic methods showed no signs of chronic liver disease. He underwent corticosteroid treatment with adequate response. After therapy withdrawal, a clinical relapse occurred. Seven months after the initial presentation, liver MR suggested initial cirrhotic changes in the right liver lobe. A liver biopsy revealed abundant lymphoplasmacytic infiltrate with piecemeal necrosis and grade 2 fibrosis. He responded well to the corticosteroid treatment again, and was further treated with low-dose prednisone without additional relapses. Several years later, further management confirmed the presence of liver cirrhosis with no histological or biochemical signs of disease activity. DIAIH is a DILI phenotype that is difficult to distinguish from idiopathic AIH despite a wide armamentarium of diagnostic methods. It should always be considered among the differential diagnoses in patients presenting with hepatocellular liver injury.https://www.mdpi.com/2039-7283/13/6/125drug-induced autoimmune hepatitisAIHDILIacute hepatitis |
| spellingShingle | Dorotea Božić Ante Tonkić Katarina Vukojevic Maja Radman A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis—Can We Draw a Line? Clinics and Practice drug-induced autoimmune hepatitis AIH DILI acute hepatitis |
| title | A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis—Can We Draw a Line? |
| title_full | A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis—Can We Draw a Line? |
| title_fullStr | A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis—Can We Draw a Line? |
| title_full_unstemmed | A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis—Can We Draw a Line? |
| title_short | A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis—Can We Draw a Line? |
| title_sort | case report idiopathic or drug induced autoimmune hepatitis can we draw a line |
| topic | drug-induced autoimmune hepatitis AIH DILI acute hepatitis |
| url | https://www.mdpi.com/2039-7283/13/6/125 |
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