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Drug Induced Autoimmune Hepatitis (DIAIH): pathological and clinical study

Drug-Induced Autoimmune Hepatitis (DIAIH) is a major part of autoimmune hepatitis (AIH). However DIAIH remains poorly characterized, especially how to differentiate DIAIH from AIH in clinical and histology. Moreover, immunosuppression treatment effectiveness has also rarely been discussed so far. In the present study, the clinical data of AIH (n=73) and drug-induced liver injury (DILI) (n=395) in Rizhao People’s Hospital during 2010 to 2014 were retrospective analysed. All AIH patients were diagnosed by simplified diagnosis criteria (2008). DIAIH were drug induced patients with positive autoimmune antibody. The results shown that all 50 AIH cases and 33 DILI cases were identified with available clinical, biochemical and histological data. Eighteen (18/395, 4.55%) of DILI patients were found to be autoimmune antibody positive (named DIAIH). Sex and age at diagnosis of AIH patients were similar to that of DIAIH, ALT, AST and bilirubin levels of DILI and DIAIH patients were significantly higher than those of AIH patients (P<0.05, respectively), and immunoglobulin of AIH patient was significantly higher than that of DIAIH (P<0.05). None of AIH patients could retreat immunosuppression successfully during follow-up, but most DIAIH patients could. AIH is prominent of portal/ portal fibrosis and Rosette formation, interface inflammation and infiltration of plasma cells. With DIAIH, it is mainly consisted by peri-central-venous inflammation and with esophilia cells dominant mixed cells. Conclusion: DIAIH is different from AIH in liver function tests, levels of immunoglobulin and pathological characteristic such as interface hepatitis, plasma cell infiltration, portal fibrosis and Rosette formation. Most DIAIH patients could retreat immunosuppression successfully.

Author(s): Hui Wang, Jindong Fu, Gang Liu, Ling Wang, Aiguo Yan, Gangping Wang