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. 2023 Nov 28;15(6):735-746.
doi: 10.3390/idr15060066.

Utility of Liver Biopsy in the Diagnosis and Management of Possible Drug-Induced Liver Injury in Patients Receiving Antituberculosis Therapy: A Retrospective Study

Gina Gualano  1 , Drieda Zace  2 , Silvia Mosti  1 , Paola Mencarini  1 , Maria Musso  1 , Raffaella Libertone  1 , Carlotta Cerva  1 , Delia Goletti  1 , Alessia Rianda  1 , Franca Del Nonno  3 , Laura Falasca  3 , Fabrizio Palmieri  1
Affiliations

Utility of Liver Biopsy in the Diagnosis and Management of Possible Drug-Induced Liver Injury in Patients Receiving Antituberculosis Therapy: A Retrospective Study

Gina Gualano et al. Infect Dis Rep. .

Abstract

Background: Drug-induced liver injury (DILI) secondary to ATT treatment (TB-DILI) is reported in 2-28% of patients. We present here a series of clinical cases of suspected DILI arising during antituberculosis treatment, studied with the aid of liver biopsy.

Methods: this was a retrospective descriptive study including 10 tuberculosis patients who underwent liver biopsy for suspected TB-DILI at the "Lazzaro Spallanzani" Institute from 2017 to 2022.

Results: Ten patients who underwent LB were extracted from the database and included in the retrospective study cohort. According to the clinical classification, eight patients had hepatocellular liver injury, one patient had cholestatic injury, and another had mixed-type injury. Histopathological diagnosis revealed liver damage due to DILI in 5/10 (50%) cases. In one case, liver biopsy showed necrotizing granulomatous hepatitis.

Conclusions: Severe and persistent elevation of hepatic transaminases, hepatic cholestasis despite discontinuation of therapy, and other suspected hepatic conditions are indications for liver biopsy, which remains a valuable tool in the evaluation of selected tuberculosis patients with suspected DILI for many reasons. However, the decision to perform a liver biopsy should be based on clinical judgment, considering the benefits and risks of the procedure.

Keywords: DILI diagnosis; DILI management; antitubercular drugs; hepatotoxicity; histology; liver biopsy; liver injury.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Histological features of DILI. (A) Interface hepatitis characterized by portal inflammatory infiltrate extending into the adjacent parenchyma; (B) higher magnification shows the presence of occasional eosinophils; (C,D) enlarged sinusoidal Kupffer cells (C) and clusters of macrophages revealed via histochemical staining with PAS-Diastase (D); (E) lobular confluent necrosis affecting groups of hepatocytes; and (F) micro- and macro-vesicular steatosis.
See this image and copyright information in PMC

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