. Author manuscript; available in PMC: 2018 Jun 1.

Published in final edited form as: Gastroenterol Clin North Am. 2017 Jun;46(2):273–296. doi: 10.1016/j.gtc.2017.01.004

Table 2.

Common Necroinflammatory and Cholestatic Injury Patterns

Pattern	Characteristic features	Non-DILI differential	ALT/ULN¹	AP/ULN¹	Frequency²
Acute (Lobular) Hepatitis	Lobular-dominant inflammation with/without confluent or bridging necrosis; no cholestasis	Acute viral hepatitis, acute autoimmune hepatitis	13 to 27	1 to 3	21%
Chronic (Portal) Hepatitis	Portal-dominant inflammation, interface hepatitis (also includes mononucleosis pattern), with or without portal-based fibrosis; no cholestasis	Chronic viral or autoimmune diseases, early PBC/PSC, mononucleosis-associated hepatitis, reactive hepatitis from systemic disease, common variable immunodeficency	3 to 10	1 to 2	14%
Zonal Coagulative Necrosis	Zone 3 or 1 coagulative necrosis, usually without significant inflammation	Hypoxic-ischemic injury (zone 3)	6 to 47	1 to 2	3%
Cholestatic Hepatitis	Acute or chronic hepatitis pattern plus zone 3 cholestasis	Acute viral hepatitis, large duct obstruction, graft-vs-host disease	2 to 13	1 to 3	29%
Acute Cholestasis (Intrahepatic, Canalicular)	Hepatocellular and/or canalicular cholestasis in zone 3; may show duct injury, but little inflammation	Sepsis, acute large duct obstruction, benign recurrent intrahepatic cholestasis	2 to 10	1 to 4	9%
Chronic Cholestasis	Periportal cholate stasis, periportal fibrosis, copper accumulation, duct sclerosis or injury, duct loss	PSC, PBC, chronic cholestatic injury/AIH overlap, chronic large duct obstruction, idiopathic adulthood ductopenia, ductopenic GVHD, IgG4 related systemic sclerosis	3 to 12	2 to 8	10%

ALT/ULN and AP/ULN - Ranges of ratios of alanine aminotransferase and alkaline phosphatase to their respective upper limits of normal (ULN) at the time of biopsy ¹⁵.

Frequencies of pattern among in a recent series of cases from the DILIN ¹⁵.