Drug-Induced Liver Injury Michael D. Leise, MD, John J. Poterucha, MD, Jayant A. Talwalkar, MD  Mayo Clinic Proceedings  Volume 89, Issue 1, Pages 95-106 (January 2014) DOI: 10.1016/j.mayocp.2013.09.016 Copyright © 2014 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure Evaluation of potential drug-induced liver injury. Testing for diseases in step 2 is as follows (see text for discussion of diagnostic pitfalls): Acute: hepatitis A, hepatitis A IgM; hepatitis B, hepatitis B surface antigen and hepatitis B core antibody IgM; hepatitis C, hepatitis C antibody test followed by HCV RNA if antibody is positive; hepatitis E, hepatitis E IgM; CMV, CMV IgM and/or PCR; EBV, EBV heterophile antibody test or EBV-specific antibody tests; AIH, anti–smooth muscle antibody, antinuclear antibody, or serum IgG (no singular test for diagnosis); Wilson's disease, ceruloplasmin; also consider ophthalmologic examination and 24-hour urine copper (no singular test for diagnosis). Chronic: NAFLD, combination of historic and imaging features ± histology (no singular test for diagnosis); alpha 1 antitrypsin deficiency, alpha 1 antitrypsin phenotype; hemochromatosis, transferrin saturation and ferritin; Celiac disease, tissue transglutaminase IgA. Miscellaneous: Biliary obstruction, ultrasound or MRCP; ischemic hepatitis (clinical diagnosis); Budd-Chiari syndrome, ultrasound with Doppler studies of hepatic veins; TPN, clinical diagnosis ± histology; congestive hepatopathy, transthoracic echocardiogram. AIH = autoimmune hepatitis; EBV = Epstein-Barr virus; CMV = cytomegalovirus; def. = deficiency; HCV, hepatitis C virus; MRCP = magnetic resonance cholangiopancreatography; NAFLD = nonalcoholic fatty liver disease; PCR, polymerase chain reaction; TPN = total parenteral nutrition. Mayo Clinic Proceedings 2014 89, 95-106DOI: (10.1016/j.mayocp.2013.09.016) Copyright © 2014 Mayo Foundation for Medical Education and Research Terms and Conditions