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The patient presented with nausea, appetite loss, and fatigue. She had received two doses of Pfizer/BioN-Tech BNT162b2 mRNA vaccine (COMIRNATY) for coronavirus disease 2019 (COVID-19). Acute liver injury was noted 14 days after the first dose of the vaccine. Re-exposure through the second dose worsened the liver injury. After liver biopsy on the third day of admission, methylprednisolone (1000 mg) was administered. Liver histology showed acute hepatitis with diffuse lobular inflammation/necrosis and lymphocyte-dominant infiltra-tion in the portal areas. The patient was diagnosed with drug-induced liver injury due to the COVID-19 vaccine based on the Digestive Disease Week Japan 2004 (DDW-J) scale, which assesses the temporal relationship, liver biopsy, and laboratory findings. With improvements in the blood test parameters, prednisolone was gradually tapered and stopped. One month later, no biochemical signs of relapse were noted. To our knowledge, this is the first report describing liver injury after the administration of the Pfizer COVID-19 vaccine in Japan.Copyright © 2022 The Japan Society of Hepatology.
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The most common causes of acute hepatitis in children are hepatitis A and autoimmune hepatitis. Hepatitis in the course of Wilson's disease is sporadically registered in adolescents. An increase of activity of aminotransferases both in the course of multisystem inflammatory syndrome in children (MIS-C) and in the course of COVID-19 has been observed. Hepatitis is common in children with MIS-C and is associated with a more severe presentation and persistent elevation of liver function tests. To date, no cases of acute hepatitis in children due to COVID-19 have been reported. We present 2 cases of acute hepatitis in children where the only cause seems to be a previous asymptomatic SARS-CoV-2 infection.Copyright © 2023 Termedia Publishing House Ltd.. All rights reserved.
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COVID-19 associated severe acute liver injury in a young healthy patient has not been reported much in the literature. And currently, there are no standard management guidelines. We want to report a case of acute liver injury of mixed pattern in a young healthy female with asymptomatic COVID-19 infection. She presented with abdominal pain, nausea, vomiting and yellowish discoloration of her skin. Further laboratory investigations revealed mixed pattern liver injury with highly raised liver enzymes. She was managed with N-acetyl cysteine protocol and monitoring of her liver enzymes. Other causes of acute liver injury were ruled out. She remained stable during her hospital stay and follow up. Our aim is to highlight the significance of acute liver injury in COVID 19 patients that may lead to fatal outcomes if not managed and monitored accordingly.
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Adenovirus, adeno-associated virus, and severe acute respiratory syndrome-coronavirus-2 (SARS-COV2) have been recently implicated as probable causative agents of severe acute hepatitis of unknown etiology reported from most of Europe. High mortality and liver transplantation (LT) rates have been observed in those presenting with acute liver failure (ALF). Such cases have not been reported from the Indian subcontinent. We analyzed the etiologies, clinical course, and in-hospital outcomes of cases of severe acute hepatitis with ALF presenting to us between May and October 2022. A total of 178 children presented with severe acute hepatitis of known/unknown etiology including 28 presenting as ALF. Eight of them fulfilled the definition of severe acute hepatitis of unknown etiology presenting as ALF. Adenovirus was not associated with cases of ALF in these children. SARS-COV2 antibodies were detected in 6 (75%) of them. Children with severe acute hepatitis of unknown etiology presenting as ALF were young (median age 4 years), had hyper-acute presentation with a predominance of gastrointestinal symptoms, and a fulminant course with worse outcomes (native liver survival 25%). Expedited evaluation of these children for LT would be the key to management.
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The World Health Organization has issued a report on 228 cases of acute hepatitis of unknown cause in children between 1 month and 16 years, 10% of them required liver transplantation and 4 died (3 in Indonesia), another 50 cases are under investigation. The adenovirus type 41 is one of the causative agents of acute gastroenteritis in children, characterized by diarrhea, vomiting and fever, often accompanied by respiratory symptoms. Cases of hepatitis in immunocompromised children have been documented;however, there is no available evidence to indicate that adenovirus type 41 can cause hepatitis in healthy children. Although adenovirus is currently hypothesized as the underlying cause, it does not fully explain the severity of the clinical picture. Given this new situation, we have more questions than answers, the reported cases had no apparent risk factors, most had not received the COVID-19 vaccine. Several hypotheses are being evaluated and it seems that the infectious cause is more solid. The possible role of previous SARS-CoV-2 infection in children reported with acute hepatitis is analyzed.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
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Introduction: The prevalence of various infectious diseases has been changing since the COVID-19 pandemic in Japan. Hepatitis A (HA) is transmitted from food and drink contaminated with the hepatitis A virus, while hepatitis E (HE) is a known zoonotic disease. The trends of HA and HE infection during the COVID-19 pandemic are unknown in Japan. Objective(s): In this study, we investigated the incidence of HA and HE before and after the COVID-19 epidemic, and compared the differences in trends between our hospital and Japanese statistics. Method(s): We investigated the number of IgA-HEV and IgM-HAV antibodies tested and positive at our hospital between January 2015 and December 2021. We verified the patient background, blood test findings and outcome of each antibody-positive. Result(s): The number of HE diagnoses /tests (rate) was 2 /187 (1.1%) in 2015, 2 /155 (1.3%) in 2016, 7 /236 (3.0%) in 2017, 11 /234 (4.7%) in 2018 and 15/ 307 (4.9%) in 2019, which was an increasing trend, but the number of tests remained the same but the number of diagnoses decreased 6 /314 (1.9%) in 2020, 2 /296 (1.0%) in 2021. According to Japanese statistics, the number of HE diagnoses showed a gradual increase from 213 in 2015 to 490 in 2019, but a slight decrease was reported in 441 in 2020 and 447 cases in 2021, respectively. On the other hand, there was no marked change in the number of HA diagnoses/tests between 2015 and 2019. 7 cases of HIV co-infection and an epidemic among Men who have Sex with Men (MSM) were observed in 2018. The number of cases decreased markedly to 0 /362 (0%) in 2020 and 0 /339 (0%) in 2021. In Japan, the number of HA diagnoses was in the 200 s from 2015 to 2017, while 925 cases were diagnosed in 2018 and 425 cases in 2019, indicating an epidemic, but the number of HA diagnoses has decreased significantly to 118 in 2020 and 69 in 2021. Conclusion(s): The number of cases of HE, a zoonosis, was reported to have decreased slightly nationwide, even with the coronary disaster, but the number of cases decreased markedly at our facility in Tokyo, suggesting the influence of changes in the lifestyle and activity patterns of the patient population. On the other hand, the number of cases of HA, which had been prevalent in recent years as a result of sexual contact among MSM, has decreased, probably due to a decrease in the influx of cases from overseas as a result of travel restrictions.
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Introduction: Syphilis is a multi-systemic disease caused by spirochete Treponema pallidum. Very rarely, it can affect the liver and cause hepatitis. Since most cases of hepatitis are caused by viral illnesses, syphilitic hepatitis can be missed. Here, we present a case of syphilitic hepatitis in a 35-year-old male. Case Description/Methods: Patient was a 35-year-old male who presented to the hospital for jaundice and mild intermittent right upper quadrant abdominal pain. His medical history was only significant for alcohol abuse. His last drink was 4 weeks ago. He was sexually active with men. On exam, hepatomegaly, mild tenderness in the right upper quadrant, jaundice, and fine macular rash on both hands and feet were noted. Lab tests revealed an ALT of 965 U/L, AST of 404 U/L, ALP of 1056 U/L, total bilirubin of 9.5 mg/dL, direct bilirubin of 6.5 mg/dL, INR of 0.96, and albumin of 2.0 g/dL. Right upper quadrant ultrasound showed an enlarged liver but was negative for gallstones and hepatic vein thrombosis. MRI of the abdomen showed periportal edema consistent with hepatitis without any gallstones, masses, or common bile duct dilation. HIV viral load and Hepatitis C viral RNA were undetectable. Hepatitis A & B serologies were indicative of prior immunization. Hepatitis E serology and SARS-CoV-2 PCR were negative. Ferritin level was 177 ng/mL. Alpha-1-antitrypsin levels and ceruloplasmin levels were normal. Anti-Smooth muscle antibody titers were slightly elevated at 1:80 (Normal < 1:20). Anti-Mitochondrial antibody levels were also slightly elevated at 47.9 units (Normal < 25 units). RPR titer was 1:32 and fluorescent treponemal antibody test was reactive which confirmed the diagnosis of syphilis. Liver biopsy was then performed which showed presence of mixed inflammatory cells without any granulomas which is consistent with other cases of syphilitic hepatitis. Immunohistochemical stain was negative for treponemes. Patient was treated with penicillin and did have Jarisch-Herxheimer reaction. ALT, AST, ALP, and total bilirubin down trended after treatment. Repeat tests drawn exactly 1 month post treatment showed normal levels of ALT, AST, ALP, and total bilirubin (Figure). Discussion(s): Liver damage can occur in syphilis and can easily be missed because of the non-specific nature of presenting symptoms. In our patient, the fine macular rash on both hands and feet along with history of sexual activity with men prompted us to test for syphilis which ultimately led to diagnosis and treatment in a timely manner. (Figure Presented).
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Introduction: Ivermectin is an antiparasitic medication that is primarily metabolized by the liver. During the COVID-19 pandemic, researchers demonstrated that Ivermectin successfully inhibited the replication of SARS-COV-2 in vivo, but current research has failed to demonstrate clinical benefit for treatment of COVID-19. Despite this, misinformation campaigns have misled patients to ingest Ivermectin at concentrations meant for domestic animals. Here, we present a case of acute liver failure secondary to the use of Ivermectin. Case Description/Methods: A 61-year-old man with medical history of ischemic cardiomyopathy with last echocardiogram showing ejection fraction at 21%, atrial fibrillation on warfarin for oral anticoagulation, and previously treated Hepatitis C presented with generalized weakness and yellowish discoloration of the skin worsening over the last two weeks. The patient denied significant alcohol use, acetaminophen use, or illicit drugs. He admitted to injecting himself with two doses of weight-based horse ivermectin, for COVID prophylaxis, two weeks prior to his presentation. Physical exam was pertinent for scleral icterus and hepatomegaly with no abdominal tenderness. Initial labs revealed elevated liver chemistries in a mixed pattern (Figure 1). Acute hepatitis panel, HSV, and CMV were negative. Hepatitis C antibodies were positive, but the patient was in sustained virologic response. Full workup for chronic liver disease was unremarkable. Ultrasound revealed hepatosplenomegaly with patent portal and hepatic vasculature. Subsequently, the patient developed hepatic encephalopathy along with his coagulopathy, raising concern for acute hepatic failure. The patient was transferred to the ICU and started on NAcetylcysteine, rifaximin, and supportive care. The patient recovered well and fortunately did not require liver transplant. Discussion(s): While the FDA recommends against the use of Ivermectin for COVID-19, many continue to inappropriately consume it. Ivermectin-induced liver failure is a rare but deadly side effect. Given our patient's rapid onset of symptoms post-self injection of Ivermectin, his liver injury was presumed to be related to Ivermectin. The drug interaction between Ivermectin and warfarin had worsened the patients coagulopathy. Physicians should be aware of the ways Ivermectin overdose may clinically present to avoid delayed treatment. This case demonstrates the detriments of perpetuation of medical misinformation to care.
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Intro: While the pediatric population has largely remained free of severe COVID- 19, in some situations SARS-CoV-2 infection has been associated with complications like Multiple Inflammatory Syndrome in children (MIS-C). Recently, cases of hepatitis in children have caused tremendous worry across the globe, we describe a unique presentation from 2021, subsequent to asymptomatic infection of SARS-CoV-2, a unique form of severe hepatitis designated by us as COVID-19 Associated Hepatitis in Children (CAH-C). The clinical presentations, temporal association, and viral parameters of CAH-C cases, and contrast to that of MIS-C cases are presented here. Method(s): As a retrospective and follow-up case-control study we reviewed all children within 14 years presenting with "sudden onset of hepatitis, elevated transaminases, non-obstructive jaundice. After performing all routine tests among them, those lacking marked inflammatory responses and without evidence of (a) other known causes of acute hepatitis (A-E) or previous underlying liver disease, and (b) multi-system involvement", being unique such cases were classified as CAH-C, and are described here. Finding(s): Among 475 children who tested positive, 37/47 cases had features of CAH-C, having symptoms of hepatitis only, with un-elevated inflammatory markers, 100% positivity for SARS-CoV-2 antibodies, and uneventful recovery. The remaining 10/47 having MIS-C had protracted illness, multiple system involvement, required admission to critical care, and a mortality rate of 30%. Among controls, only 26/50 (52%) had SARS-CoV-2 antibodies. Discussion(s): During the pandemic, various COVID-19 complications have been observed posing safety concerns, where our study identified a unique form of acute hepatitis in children designated as CAH-C. Conclusion(s): With the emergence of newer variants, including the Delta variant which predominated the second wave of infections in India and spread worldwide with changing presentations and complications, CAH-C is such new entity in children. It needs early identification and differentiation from other emerging syndromes during the ongoing pandemic for preventing adversities through timely intervention.Copyright © 2023
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Intro: Event-based surveillance (EBS) and rapid risk assessment (RRA) are essential tools for the early warning system against outbreaks, especially in the initial stages of an incident of potential public health threat. Since the Middle East respiratory syndrome outbreak in 2015, Korea Disease Control and Prevention Agency (KDCA) established EBS and RRA systems. This paper described KDCA's implementation of EBS and RRA to support the decision-making process for acute public health events. Method(s): The process of EBS and RRA systems for potential public health threats occurring outside of Korea is described and potential barriers and challenges are discussed. Finding(s): EBS and RRA systems have been constantly utilized in Korea. One of the recent examples is the EBS and RRA activities for acute hepatitis of unknown etiology in children and the global monkeypox outbreak which provided the basis to establish timely surveillance and response systems. Discussion(s): EBS tends to rely heavily on access to timely information. The quality of information needs to be ensured through a verification process by trained personnel as the quality of information determines the credibility of EBS results. Efforts to strengthen the information coverage and enhance the quality of information are key elements of EBS and RRA. Standardized manuals and systematic implementation of the EBS and RRA enable a more accurate evaluation of the risk. The process of RRA also needs flexibility in the way the risk is estimated. Conclusion(s): Public health threats are more likely to be imported than before as exchanges among countries grow frequent due to the eased border control measures for COVID-19 in recent days. The EBS and RRA systems are essential tools for all countries to ensure a timely response. Efforts to improve access to timely information and to ensure the quality of information should be continuously made to improve EBS and RRA systems.Copyright © 2023
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Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), first emerging in December 2019 and continuously evolving, poses a considerable challenge worldwide. It was reported in the literature that neonates had mild upper respiratory symptoms and a better outcome after Omicron SARS-CoV-2 variant infection, but there was insufficient data about complications and prognosis. Case Presentation: In this paper, we present the clinical and laboratory characteristics of four COVID-19 neonate patients with acute hepatitis during the Omicron SARS-CoV-2 variant wave. All patients had a clear history of Omicron exposure and were infected via contact with confirmed caregivers. Low to moderate fever and respiratory symptoms were the primary clinical manifestations, and all patients had a normal liver function at the initial stage of the course. Then, the fever lasted 2 to 4 days, and it was noted that hepatic dysfunction might have occurred 5 to 8 days after the first onset of fever, mainly characterized by moderate ALT and AST elevation (>3 to 10-fold of upper limit). There were no abnormalities in bilirubin levels, blood ammonia, protein synthesis, lipid metabolism, and coagulation. All the patients received hepatoprotective therapy, and transaminase levels gradually decreased to the normal range after 2 to 3 weeks without other complications. Conclusions: This is the first case series about moderate to severe hepatitis in COVID-19 neonatal patients via horizontal transmission. Besides fever and respiratory symptoms, the clinical doctor should pay much attention to evaluating the risk of liver function injury after SARS-CoV-2 variants infection, which is usually asymptomatic and has a delayed onset.
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Acute hepatitis of unknown origin in children has been recently described in the literature, and a case definition has also been proposed for this condition. The exact etiology is unknown and exclusion of infectious, metabolic, autoimmune and toxin mediated injuries is essential. Management for this condition is supportive, but some may require liver transplantation. Infection prevention and control practices are important as the etiology remains unidentified.Copyright © 2023, Indian Academy of Pediatrics.
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Hepatitis A is a common viral infection worldwide that is transmitted via the fecal-oral route. Since the introduction of an efficient vaccine, the incidence of infection has decreased but the number of cases has risen due to widespread community outbreaks among unimmunized individuals. Classic symptoms include fever, malaise, dark urine, and jaundice, and are more common in older children and adults. People are often most infectious 14 days prior to and 7 days following the onset of jaundice. We will discuss the case of a young male patient, diagnosed with acute hepatitis A, leading to fulminant hepatitis refractory to conventional therapy and the development of subsequent kidney injury. The medical treatment through the course of hospitalization was challenging and included the use of L-ornithine-L-aspartate and prolonged intermittent hemodialysis, leading to a remarkable outcome. Hepatitis A is usually self-limited and vaccine-preventable;supportive care is often sufficient for treatment, and chronic infection or chronic liver disease rarely develops. However, fulminant hepatitis, although rare, can be very challenging to manage as in the case of our patient.Copyright © 2023 The Author(s).
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The impact that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has on the hepatobiliary system is poorly described in the pediatric population compared with the adult population. In adults, gastrointestinal symptoms and marked elevation in liver enzymes in the setting of coronavirus disease 2019 (COVID-19) has been directly correlated with disease severity. This case is a unique presentation of a pediatric patient with a relatively mild disease course despite the presence of gastrointestinal symptoms and marked elevation in transaminases, suggesting that SARS-CoV-2 virus may cause isolated acute hepatitis in pediatric patients.
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The proportion of pediatric cases with severe acute hepatitis of unknown etiology in the coronavirus disease 2019 era was higher than that in the pre-coronavirus disease 2019 era in Japan's largest pediatric transplant center. Further research and monitoring are essential.
Subject(s)
COVID-19 , Hepatitis , Liver Transplantation , Child , Humans , Liver Transplantation/adverse effects , Japan , Hepatitis/etiologyABSTRACT
A 55-year-old male patient presented to our outpatient clinic with complaints of dark urine and fatigue. The laboratory parameters were as follows: alanine aminotransferase 821 IU/L, aspartate aminotransferase 1042 IU/L, alkaline phosphatase 412 IU/L gamma-glutamyl transferase 268 IU/L and the complete urinalysis revealed hematuria, while other laboratory parameters were normal. The patient's abdominal ultrasonography (USG) and Doppler USG showed no pathological finding. Hepatitis and the other serologies were negative. The patient, who did not exhibit any symptoms of Coronavirus disease-2019 (COVID-19) initially, exhibited bilateral opacities in the middle zones on chest X-ray taken after the development of fever and dyspnea on the third day of hospitalization. The computed tomography scan revealed segmental consolidation across the subpleural regions, mostly in the middle zones, and was evaluated to be consistent with COVID-19. COVID-19 treatment was planned for the patient whose nasopharyngeal swab tested positive for severe acute respiratory syndrome-Coronavirus-2.
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There has been an increasing number of reported cases of acute hepatitis of unknown origin in previously healthy children since first reported on March 31, 2022. This clinical syndrome is identified by jaundice and markedly elevated liver enzymes with increased aspartate transaminase and/or alanine aminotransaminase (greater than 500 IU/L). We conducted an inclusive literature review with respect to acute hepatitis outbreaks in children using the search terms acute hepatitis, outbreak, children, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), coronavirus disease 2019 (COVID-19), and adenovirus. According to the cumulative data presented in four main studies, the median age is 4 years, with a male predominance (1.3:1). Jaundice was the most common clinical manifestation (69%), followed by vomiting (63%), anorexia (52.9%), diarrhea (47.2%), abdominal pain (39%), pyrexia (33.3%), pale stool (30%), and dark urine (30%). Coryza and lethargy were reported in 16.6%, while pruritus was reported in 2% of cases. Acute liver failure was observed in 25% of cases. The exact mechanism of this acute hepatitis outbreak is still not entirely clear. Adenoviruses and SARS-CoV-2 were detected in a significant number of patients. Coinfection with adenovirus and SARS-CoV-2 could be a possible underlying mechanism. However, other possible infections and mechanisms must be considered in the pathogenesis of this condition. Acute hepatitis of unknown origin in children has been a serious problem since the start of the COVID-19 pandemic but has not yet been sufficiently addressed. Many questions remain regarding the underlying mechanisms leading to acute liver failure in children, and it is likely that extensive future research is needed.
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Viral infections affecting the liver had a serious impact on humanity, as they have led to significant morbidity and mortality in patients with acute and chronic infections. The discovery of the viral agents of severe acute hepatitis in children triggered interest of the scientific community to establish the pathogenesis and diagnostic techniques to identify the affected population. But, WHO, together with scientists in various affected countries, are working to understand the cause of this infection that does not appear to belong to any of the known five types of hepatitis viruses: A, B, C, D and E. Many cases of severe acute hepatitis of unknown origin in children <10 years of age were reported by the International Health Regulations (IHR) was mainly by adenovirus infection, HAdV-41. Although most acute infections cause mild disease and even go undetected, some can lead to complications and turn fatal. With the rapid scientific and technological advances in the last centuries, controlling and even curing the infections became a possibility, with a large focus on preventive medicine through vaccination. The review article describes the epidemiology, pathogenesis, clinical presentation, diagnostic tools and current medication regimens for severe acute hepatitis of unknown origin in children.Copyright © 2022, Global Research Online. All rights reserved.
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Introduction and Objectives: Cases suggestive of immune-mediated acute hepatitis following SARS-CoV-2 vaccination have been reported. The risk of liver injury after Covid-19 vaccination is unknown. This study aimed to estimate the cumulative incidence of liver injury within 90 days after the Covid-19 vaccine, defined as the occurrence of AST and/or ALT increases at least two times the limit of normal or ALP increases at least x 2. To compare with an active comparator group (influenza vaccine). Material(s) and Method(s): Retrospective cohort study. We analyze a consecutive sample of adult patients vaccinated with Covid-19 vaccines (Sputnik, AstraZeneca/Oxford, Covishield, or Sinopharm) between January 1 and May 30, 2021, and a historical control group vaccinated with influenza between March 1 and July 30, 2019. Qualifying labs were collected as part of routine clinical care or the development of symptoms. Result(s): From a total of 29,918 subjects who received the Covid-19 vaccine in 2021 and 24,753 who received the Influenza vaccine in 2019, 130 and 148 patients, respectively, were excluded because of previously altered liver function tests or known hepatic disease. Both groups were comparable in age (73 years old (IQR 65-80), p=0.125) and gender (67% were females). In the Influenza group were more dysmetabolic and immunosuppressed patients. A total of 269 and 273 patients, respectively, presented altered liver function tests within 90 days post-vaccination. The cumulative incidence of liver injury was 4.6 per 1,000 (95% CI 3.9-5.5) for Covid-19 and 5.1 per 1,000 (95%CI 4.3-6.1) for Influenza (p=0.453). Although, two patients from the COVID group had a more severe injury, with hyperbilirubinemia, development of autoantibodies and requirement of steroids for disease control. Conclusion(s): The occurrence of events was similar in subjects vaccinated with Covid-19 compared to the control group. Acute hepatitis characteristics arising after the COVID-19 vaccine needs to be further clarified.Copyright © 2023
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Introduction and Objectives: Acute autoimmune-like liver injury has been increasingly reported after vaccination against SARS-CoV-2. Pathogenesis, steroid requirement and long-term prognosis are unknown. This study aimed to evaluate clinical, serological and histological features, response to treatment and prognosis in patients with post-vaccination acute hepatitis. Material(s) and Method(s): We included patients without known pre-existing liver diseases with transaminase levels >= 2.5 upper limits of normal within 90 days after the SARS-CoV-2 vaccine with an available liver biopsy. Clinical data and outcomes after a six months follow-up were collected. Result(s): 17 patients were included,12 females, median age 60 (51,5/66) exposed to vectorial (Sputnik V n=7, AstraZeneca n=6), inactivated (Sinopharm n=3) or ARNm Vaccines (Moderna=1). In 8 patients, liver injury developed after the first dose and in 7 after the second dose and in 2 after the third dose. The median time to the development of injury was 33(23,50/53,50) days. Eight patients had a history of extrahepatic autoimmune disease and five patients had metabolic syndrome and used statins. Immune serology showed anti-antinuclear antibody in 10 (58,8%), anti-smooth muscle antibody in 5(29,4%). 14/17 patients presented with elevated IgG levels. Liver histology showed lobular hepatitis in 13/17, portal hepatitis in 17/17 with plasmocytic lymphocytic infiltrate and 4/17 had eosinophils, 6/17 with severe interface hepatitis, and one patient had fibrosis Ishak stage >=3. 12/17 (70,5%) were treated with steroids. Transaminases improved in 17 cases and normalized in 6/12 by month 6. Only 1/17 developed liver function deterioration, yet no patient required liver transplantation. Most patients tolerated the tapering of steroids and in 6 azathioprine was started before month 3. Conclusion(s): Long-term follow-up might help to differentiate between induced classical autoimmune hepatitis, autoinflammatory self-limited events, or drug-induced liver injury in these patients.Copyright © 2023