Drug-induced liver injury mimics almost every pattern of hepatitis and cholestasis, and the histology alone rarely names the drug. Before reporting a medical liver biopsy, ask for a full medication list — including oncology drugs, antibiotics, herbal and traditional remedies and supplements — with start and stop dates relative to the rise in enzymes. Report the pattern, state whether it is compatible with drug injury, and leave causality to the clinical team using a structured tool such as RUCAM.
- Request a full medication list with dates on every medical liver biopsy.
- Ask specifically about herbal, ayurvedic and over-the-counter products.
- Describe the injury pattern and state whether drug injury is compatible.
- Do not diagnose autoimmune hepatitis on serology alone when the histology does not support it.
Why it matters
Without the timeline, drug injury is often reported as autoimmune or viral hepatitis and treated wrongly.
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