Autoimmune-like hepatitis induced by drugs: Still many unanswered questions

Table 2 Comparative studies assessing liver cellularity in classic autoimmune hepatitis vs drug-induced autoimmune-like hepatitis

Ref.	Design and cohort	Main histological findings
Chung et al[19], 2024	Retrospective cohort; 28 DI-ALH vs 39 idiopathic AIH cases	DI-ALH exhibited significantly fewer plasma cell aggregates (61% vs 97%, P < 0.001), more eosinophilic aggregates (18% vs 3%), and lower portal inflammation and fibrosis (mean Ishak 1.9 vs 3.5)
de Boer et al[14], 2017	Immunohistochemical profiling of autoimmune-DILI, idiopathic AIH, viral hepatitis	Infiltrates were predominantly CD8+ T cells across all groups. Idiopathic AIH showed significantly more CD20+ B cells and plasma cells compared to DILI-AILH, which had fewer of both
Tsutsui et al[27], 2020	Comparative clinicopathological study: Acute AIH vs DILI (Japan)	Acute AIH demonstrated greater lobular necrosis, hepatocellular rosettes, and dense plasma-cell infiltrates than DILI (all P < 0.01), supporting these as discriminating features
Suzuki et al[12], 2011	Histological scoring (DDWJ 2004) in AIH vs DILI	AIH scored significantly higher for portal inflammation, interface hepatitis, and plasma-cell infiltration than DILI (P < 0.012), confirming DDW-J scale’s diagnostic value. DI-ALH often showed portal-lobular inflammation
Björnsson et al[13], 2022	Systematic review of 186 DI-ALH case reports	DI-ALH often shows portal-lobular lymphoplasmacytic inflammation, hepatocyte rosettes, and focal necrosis, mirroring AIH histology

AIH: Autoimmune hepatitis; DI-ALH: Drug-induced autoimmune-like hepatitis; DILI: Drug-induced liver injury; DDW-J: Digestive Disease Week from Japan.