Idiosyncratic drug-induced liver injury (DILI) is frequently encountered in gastroenterology and hepatology practices and can have numerous presentations, varying from asymptomatic elevations in liver biochemistries to hepatocellular or cholestatic jaundice, liver failure, or chronic hepatitis. Antimicrobials, herbal and dietary supplements, and anticancer therapeutics (e.g., tyrosine kinase inhibitors or immune-checkpoint inhibitors) remain the commonest agents causing DILI in the Western world. 

DILI represents the diagnosis of exclusion, and thus other etiologies of liver disease should be neatly assessed before confirming a diagnosis of DILI. Model for end-stage liver disease score and comorbidity burden are crucial determinants of mortality in patients with suspected DILI. DILI, when present with hepatocellular jaundice, carries a mortality rate up to 10%. Patients with DILI, developing progressive jaundice with or without coagulopathy, needs a referral to a tertiary care center for specialized care, including consideration for potential liver transplantation. 

The role of systemic corticosteroids remains controversial. However, they could be used when a liver injury event is difficult to be differentiated between autoimmune hepatitis or DILI or when a DILI event presents with prominent autoimmune hepatitis features.

Source- Am J Gastroenterol. 2021;116(5):878-898. doi: 10.14309/ajg.0000000000001259. PMID: 33929376.