Table 3.

Biopsy Reported Phenotypes of Drug Induced Liver Injury and Agents

Phenotype	Histologic feature	Example
Acute hepatic necrosis	Collapse and centrolobular necrosis (Fig. 3)	Acetaminophen, isoniazid
Acute fatty liver with lactic acidosis	Microvesicular hepatic steatosis; later with macrovesicular steatosis	Didanosine, valproate
Acute viral hepatitis like	Inflammatory infiltrates	Isoniazid, flutamide
Autoimmune-like hepatitis	Plasma cell infiltration and interface hepatitis	Minocycline, nitrofurantoin
Bland cholestasis	Ballooned hepatocytes with minimal inflammation	Anabolic steroids
Cholestatic hepatitis	Ballooned hepatocytes with inflammation	Amoxicillin-clavulanate, phenytoin
Cirrhosis	Fibrosis without inflammation	Methotrexate, amiodarone
Immunoallergic hepatitis	Eosinophilic infiltration	Phenytoin, trimethoprim-sulfamethoxazole
Nodular regeneration	Microscopic or macroscopic liver nodules without fibrosis	Azathioprine, oxaliplatin
Nonalcoholic fatty liver	Micro/macrosteatosis, ballooned hepatocytes, periportal inflammation	Methotrexate, tamoxifen
Sinusoidal obstruction syndrome	Obliteration of central veins with inflammation	Busulfan
Vanishing bile duct syndrome	Loss of small inter- and intralobular bile ducts (Fig. 1)	Sulfonamides and β-lactams