Table 4.

Characteristics of 8 patients with changes in causality scores from a 4 to a 3 or a 3 to a 4 after liver biopsy review.

Age years	Sex	Injury	Implicated Drug	Time to biopsy [days]	Pre-Bx score	Post-Bx score	Peak ALT [U/L]	Peak Alk P [U/L]	Peak T bili [mg/dL]	Viral serology	AI serology	Imaging	Histological Findings and comment
85	F	HC	Levofloxacin	2	4	3	980	120	3.2	HCV RNA Pos	Pos	Neg	Chronic cholestasis and acute hepatitis superimposed on underlying chronic viral hepatitis and NASH. Despite two preexisting liver diseases, the pathology cannot be explained by either. Fluoroquinolones have been associated with both acute hepatitis and cholestatic injury patterns.
67	M	Chol	Voriconazole	7	4	3	606	1310	9.7	Neg	NA	Neg	Acute cholestasis and necrosis superimposed on HSCT-associated NRH and obliterative portal venopathy. Other cause of cholestasis excluded by history and azole antifungals are associated with both acute hepatitis and cholestatic injury patterns.
48	F	Chol	Azithromycin	12	4	3	239	1406	5.3	Neg	Neg	Neg	Changes of chronic cholestasis superimposed on HSCT or AML-associated NRH and obliterative portal venopathy. Although the cholestatic findings are subtle, they coincide with the clinical picture cholestatic injury and azithromycin is known to cause chronic cholestatic injury.
62	M	HC	Amiodarone	29	4	3	781	168	7.7	Neg	Pos	Bil dil	Cirrhosis with numerous Mallory-Denk bodies and mild steatosis. The injury is typical for cirrhosis related to amiodarone.
52	M	Chol	Cefuroxime	28	4	3	268	651	8.4	Neg	Neg	Neg	Chronic cholestasis with zone 3 necrosis, no changes to suggest PBC or PSC. Unusual combination injury favors DILI and cephalosporins are associated with cholestatic injury patterns.
26	F	HC	Infliximab	25	4	3	2894	200	4.4	Neg	Neg	Neg	Acute hepatitis with prominent plasma cell infiltrates. Infliximab is associated with AIH-like pathology and the autoimmune serologies were negative.
46	F	Chol	Amoxicillin	9	3	4	450	723	25.7	Neg	Pos	Neg	Acute hepatitis with diffuse parenchymal injury, venulitis, no cholestasis. Atypical for amoxicillin, which typically shows cholestatic hepatitis.

Abbreviations: F, female; M, male; HC, hepatocellular; Chol, cholestatic; Bx, biopsy; HCV, hepatitis C virus, NA, not available; Bil dil, biliary dilatation; AIH, autoimmune hepatitis; HSCT, hematopoietic stem cell transplant; NRH, nodular regenerative hyperplasia; AML, acute myelogenous leukemia; PBC, primary biliary cholangitis; PSC, primary biliary sclerosis.