Drug Liver Injury Induced by Olmesartan Mediated by Autoimmune-Like Mechanism: A Case Report

Authors

• Manuel de la Torre-Aláez Liver Unit, Clínica Universidad de Navarra, Madrid, Spain
• Mercedes Iñarrairaegui Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain

mdalaez@unav.es

Keywords

Abstract

Autoimmune hepatitis (AIH) was the first liver disease for which an effective therapeutic intervention was carried out, using prednisolone; its usefulness was demonstrated in several clinical trials. Nevertheless, AIH still remains a difficult diagnosis in some cases, because it is necessary to dismiss other possible diagnoses, and perhaps due to it being a heterogeneous disease. The relationship between drug-induced liver injury (DILI) and AIH is complex and not fully understood. There are three possible scenarios: (1) DILI with a strong immunoallergic component mimicking AIH; (2) AIH mimicking a DILI due to drug exposure and (3) AIH triggered by exposure to an offending drug (drug-induced AIH). Drug-induced AIH is well described and documented for some drugs such as nitrofurantoin and minocycline. Histologically distinguishing DILI from AIH remains a challenge. We present an interesting case report which met serologic criteria and histological confirmation to establish AIH, but discontinuation of a suspected drug resolved hypertransaminasaemia.