Autoimmune Hepatitis-Induced by Drugs: a Challenging Diagnosis

Purpose of Review: The aim of the current review is to perform an analysis of data in recent years that might be helpful to distinguish between autoimmune hepatitis (AIH) and drug-induced autoimmune hepatitis (DIAIH). Recent Findings: Well-established drugs leading to DIAIH have been shown to be hydralazine, methyldopa, minocycline, and nitrofurantoin. More recently anti-TNF-alpha antagonists have been increasingly reported to lead to DIAIH, most commonly infliximab, DIAIH can be defined as drug-induced liver injury (DILI) with the presence of ANA and/or SMA and elevated IgG. Histology has not been shown to be valuable to predict requirement of corticosteroids. The new simplified criteria for AIH have not been shown to predict requirement of steroids. Corticosteroids should be considered in patients who do not show improvement in ALT after discontinuation of the implicated agent. Summary: Lack of relapse after discontinuation of corticosteroids seems to distinguish between DIAIH patients and those with classical AIH. has been show nto be one of the most common cause of DIAIH nowadays.