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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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Autores principales: Božić, Dorotea, Tonkić, Ante, Vukojevic, Katarina, Radman, Maja
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10660691/
https://www.ncbi.nlm.nih.gov/pubmed/37987426
http://dx.doi.org/10.3390/clinpract13060125
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author Božić, Dorotea
Tonkić, Ante
Vukojevic, Katarina
Radman, Maja
author_facet Božić, Dorotea
Tonkić, Ante
Vukojevic, Katarina
Radman, Maja
author_sort Božić, Dorotea
collection PubMed
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.
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spelling pubmed-106606912023-11-13 A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis—Can We Draw a Line? Božić, Dorotea Tonkić, Ante Vukojevic, Katarina Radman, Maja Clin Pract Case Report 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. MDPI 2023-11-13 /pmc/articles/PMC10660691/ /pubmed/37987426 http://dx.doi.org/10.3390/clinpract13060125 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Božić, Dorotea
Tonkić, Ante
Vukojevic, Katarina
Radman, Maja
A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis—Can We Draw a Line?
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 Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10660691/
https://www.ncbi.nlm.nih.gov/pubmed/37987426
http://dx.doi.org/10.3390/clinpract13060125
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