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Drug Induced Toxicity

 

Patterns of Injury in Drug- and Toxin-Induced Hepatic Injury

Pattern of Injury

Morphologic Findings

Examples of Associated Agents

Cholestatic

Bland hepatocellular cholestasis, withoutinflammation

Contraceptive and anabolic steroids; estrogenreplacement therapy

Cholestatic hepatitis

Cholestasis with lobular necroinflammatory activity;may show bile duct destruction

Numerous antibiotics; phenothiazines

Hepatocellular necrosis

Spotty hepatocyte necrosis

Methyldoya, phenytoinDescription: View drug information

Submassive necrosis, zone 3

AcetaminophenDescription: View drug information, halothaneDescription: View drug information

Massive necrosis

IsoniazidDescription: View drug information, phenytoinDescription: View drug information

Steatosis

Macrovesicular

Ethanol, methotrexate, corticosteroids, total parenteralnutrition

Steatohepatitis

Microvesicular, Mallory bodies

Amiodarone, ethanol

Fibrosis and cirrhosis

Periportal and pericellular fibrosis

Methotrexate, isoniazidDescription: View drug information, enalapril

Granulomas

Noncaseating epithelioid granulomas

Sulfonamides, numerous other agents

Vascular lesions

Sinusoidal obstruction syndrome (veno-occlusivedisease): obliteration of central veins

High-dose chemotherapy, bush teas

Budd-Chiari syndrome

Oral contraceptives

Sinusoidal dilatation

Oral contraceptives, numerous other agents

Peliosis hepatis: blood-filled cavities, not lined byendothelial cells

Anabolic steroids, tamoxifen

Neoplasms

Hepatic adenoma

Oral contraceptives, anabolic steroids

Hepatocellular carcinoma

Thorotrast

Cholangiocarcinoma

Thorotrast

Angiosarcoma

Thorotrast, vinyl chloride





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