From the Guidelines
Drug-induced hepatitis and autoimmune hepatitis can be distinguished by their clinical presentation, histological features, and response to treatment, with drug-induced hepatitis typically resolving after discontinuation of the offending drug, whereas autoimmune hepatitis requires immunosuppressive therapy. The symptoms of both conditions can be similar, including fatigue, jaundice, abdominal pain, nausea, vomiting, and elevated liver enzymes 1. However, drug-induced hepatitis usually develops within days to weeks after starting a new medication and often improves when the offending drug is discontinued, with minocycline and nitrofurantoin accounting for 90% of drug-induced autoimmune-like hepatitis 1.
Some key differences between the two conditions include:
- The frequency of acute onset, which is higher in drug-induced hepatitis (66%) compared to autoimmune hepatitis (16%) 1
- The presence of cirrhosis at presentation, which is more common in autoimmune hepatitis (16-28%) than in drug-induced hepatitis (0%) 1
- The response to treatment, with drug-induced hepatitis typically resolving after discontinuation of the offending drug, whereas autoimmune hepatitis requires immunosuppressive therapy and often recurs or relapses after cessation of corticosteroid therapy (50-87%) 1
- Histological features, such as the presence of portal neutrophils and intracellular cholestasis, which may suggest drug-induced disease 1
In terms of treatment, discontinuation of the offending drug is often sufficient to resolve drug-induced hepatitis, but immunosuppressive therapy with corticosteroids and azathioprine may be necessary for autoimmune hepatitis. The decision to start treatment should be based on a careful evaluation of the patient's clinical presentation, laboratory results, and histological features, as well as the potential risks and benefits of each treatment approach 1.
From the Research
Drug-Induced vs Autoimmune Hepatitis Symptoms
The symptoms of drug-induced liver injury (DILI) and autoimmune hepatitis (AIH) can be similar, making diagnosis challenging.
- DILI can cause a range of symptoms, including fatigue, nausea, vomiting, and abdominal pain, which are also common in AIH 2.
- AIH is characterized by symptoms such as fatigue, arthralgias, and jaundice, which can also be present in DILI 3, 4, 5, 6.
- The key to differentiating between the two conditions is to identify the underlying cause of the liver injury.
- In DILI, the liver injury is caused by the use of certain medications or herbal supplements, and symptoms typically improve after the offending agent is withdrawn 2.
- In AIH, the liver injury is caused by an autoimmune response, and treatment typically involves the use of immunosuppressive medications such as prednisone and azathioprine 3, 4, 5, 6.
Treatment and Management
The treatment and management of DILI and AIH also differ.
- In DILI, treatment consists of rapid drug discontinuation and supportive care to alleviate symptoms 2.
- In AIH, treatment typically involves the use of immunosuppressive medications, and the goal is to induce and maintain remission 3, 4, 5, 6.
- In some cases, patients with AIH may require liver transplantation, especially if they have decompensated disease or have not responded to medical therapy 3, 4.