Drug-induced Liver Injury: Pathology Patterns and Common Culprits

Drug-induced liver injury (DILI) has an incredible range of morphologic presentations, from acute extensive necrosis to resolving injury with ceroid-laden macrophages. The diversity in presentation on biopsy is diagnostically challenging, but DILI is becoming more widely recognized, especially with the aid of resources like LiverTox. Some medications, such as acetaminophen, have well-established patterns of injury. However, newer medications, such as immune checkpoint inhibitors, are continually being developed, and our understanding of their effects on the liver are evolving. In this chapter, we will focus on the DILI patterns and frequently encountered DILI culprits. Ultimately, DILI is a diagnosis of exclusion, and close clinical correlation is essential when navigating the differential.