Skip to main content
. 2016 Jul 19;3(3):18. doi: 10.3390/medicines3030018

Table 9.

Checklist of differential diagnoses in cases of liver injury due to TCM herbs.

Differential Diagnosis Diagnostic Parameters Diagnostic Exclusion Done for Patient’s Causality Assessment
Yes No Partial

  • Hepatitis A virus (HAV)

 Anti-HAV-IgM □ □ □

  • Hepatitis B virus (HBV)

 HBV-DNA, anti-HBc-IgM □ □ □

  • Hepatitis C virus (HCV)

 HCV-RNA, anti-HCV □ □ □

  • Hepatitis E virus (HEV)

 HEV-RNA , titer change for anti-HEV-IgM/anti-HEV-IgG □ □ □

  • Cytomegalovirus (CMV)

 CMV-PCR, titer change for anti-CMV-IgM/anti-CMV-IgG □ □ □

  • Epstein Barr virus (EBV)

 EBV-PCR, titer change for anti-EBV-IgM/anti-EBV-IgG □ □ □

  • Herpes simplex virus (HSV)

 HSV-PCR, titer change for anti-HSV-IgM/anti-HSV-IgG □ □ □

  • Varicella zoster virus (VZV)

 VZV-PCR, titer change for anti-VZV-IgM/anti-VZV-IgG □ □ □

  • Other virus infections according to the clinical context

 Specific serology of Adenovirus, Coxsackie-B-Virus, Echovirus, Measles virus, Rubella virus, Flavivirus, Arenavirus, Filovirus, Parvovirus, HIV, and others □ □ □

  • Other infectious diseases

 Specific assessment of bacteria, fungi, parasites, worms, and others □ □ □

  • Autoimmune hepatitis (AIH) type I

 Gamma globulins, ANA, SMA, AAA, SLA/LP, Anti-LSP, Anti-ASGPR □ □ □

  • Autoimmune hepatitis (AIH) type II

 Gamma globulins, Anti-LKM-1 (CYP 2D6), Anti-LKM-2 (CYP 2C9), Anti-LKM-3 □ □ □

  • Primary biliary cholangitis (PBC)

 AMA, Anti PDH-E2 □ □ □

  • Primary sclerosing cholangitis (PSC)

 p-ANCA, MRC □ □ □

  • Autoimmune cholangitis (AIC)

 ANA, SMA □ □ □

  • Overlap syndromes

 See AIH, PBC, PSC, and AIC □ □ □

  • Non alcoholic steatohepatitis (NASH)

 BMI, insulin resistance, hepatomegaly, echogenicity of the liver □ □ □

  • Alcoholic liver disease (ALD)

 Patient’s history, clinical and laboratory assessment, other alcoholic disease(s) □ □ □

  • Drug induced liver injury (DILI) or herb induced liver injury (HILI)

 Patient’s history, clinical and laboratory assessment, sonography, use of the updated RUCAM □ □ □

  • Cocaine, ecstasy and other amphetamines

 Toxin screening □ □ □

  • Rare intoxications

 Toxin screening for household and occupational toxins □ □ □

  • Hereditary hemochromatosis

 Serum ferritin, total iron-binding capacity, genotyping for C2824 and H63D mutation, hepatic iron content □ □ □

  • Wilson disease

 Copper excretion (24 h urine), ceruloplasmin in serum, free copper in serum, Coombs-negative hemolytic anemia, hepatic copper content, Kayser-Fleischer-ring, neurologic-psychiatric work-up, genotyping □ □ □

  • Porphyria

 Porphobilinogen in urine, total porphyrines in urine □ □ □

  • α1-Antitrypsin deficiency

 α1—Antitrypsin in serum □ □ □

  • Biliary diseases

 Clinical and laboratory assessment, hepatobiliary sonography, MRC □ □ □

  • Pancreatic diseases

 Clinical and laboratory assessment, sonography, CT, MRT □ □ □

  • Celiac disease

 TTG antibodies, endomysium antibodies, duodenal biopsy □ □ □

  • Anorexia nervosa

 Clinical context □ □ □

  • Parenteral nutrition

 Clinical context □ □ □

  • Cardiopulmonary diseases

 Cardiopulmonary assessment of congestive heart disease, myocardial infarction, cardiomyopathy, cardiac valvular dysfunction, pulmonary embolism, pericardial diseases, arrhythmia, hemorrhagic shock, and various other conditions □ □ □

  • Addison’s disease

 Plasma cortisol □ □ □

  • Thyroid diseases

 TSH basal, T4, T3 □ □ □

  • Grand mal seizures

 Clinical context of epileptic seizure (duration > 30 min) □ □ □

  • Heat stroke

 Shock, hyperthermia □ □ □

  • Polytrauma

 Shock, liver injury □ □ □

  • Systemic diseases

 Specific assessment of sarcoidosis, amyloidosis, metastatic tumor, sepsis, and others □ □ □

  • Other diseases

 Clinical context □ □ □