Doxycycline-Induced Autoimmune Hepatitis

Abstract

Doxycycline and minocycline are tetracyclines with the potential to cause hepatoxicity. Although autoimmune-like hepatitis from minocycline is well-described, doxycycline-induced autoimmune hepatitis (DIAH) has only been described once. We report a rare case of DIAH with elevated liver enzymes over 5 times the normal upper limit, elevated immunoglobulin G, and high titers of antismooth muscle antibody and antinuclear antibody. By stopping doxycycline, our patient's liver enzymes normalized and immunoglobulin G and autoantibody titers rapidly downtrended. As long-term doxycycline therapy becomes more prevalent to treat acne vulgaris and other skin conditions, DIAH may become more prevalent and recognized.

Figure 1.

Mild, predominantly lobular lymphohistiocytic and lymphoplasmacytic inflammation with focal interface hepatitis.

Figure 2.

Periodic acid-Schiff-diastase stain highlights scattered lobular and portal ceroid-laden macrophages.

Figure 3.

Trichrome special stain highlights areas of hepatocyte dropout; no definite fibrosis.