Not your usual drug-induced liver injury: Dolutegravir-associated granulomatous hepatitis

Dolutegravir is an integrase inhibitor in first-line antiretroviral therapy in South Africa. We describe a patient who developed severe drug-induced liver injury on dolutegravir-containing antiretroviral treatment, in whom liver biopsy demonstrated subacute hepatic necrosis, non-necrotising granulomatous inflammation, and bile duct injury: an uncommon histological pattern in dolutegravir-associated hepatotoxicity.