Drug-induced liver injury (DILI) is a well known adverse reaction of many drugs. Direct toxic liver damage is associated with paracetamol toxicity whereas most other drugs causing liver damage have an unpredictable or idiosyncratic pattern of injury. Although idiosyncratic liver injury was initially thought to be dose independent, it has been shown that many drugs leading to idiosyncratic injury have a dose dependent component. Physicians need to bear in mind DILI in all patients who present with symptoms or signs of liver dysfunction. Clinically and histologically DILI can mimick any known liver disease and there are no pathognomonic histological features of DILI. The diagnosis is one of exclusion. In patients with a high clinical suspicion of DILI the causative drug need to be discontinued and patients with jaundice and/or coagulopathy have to be hospitalized and some cases considered for a liver transplantation.

Figure 1. Causes of acute liver failure in University Hospitals in Sweden, 1994-2003.

Figure 2. Necrosis (hepatocyte drop out) associated with vein in the central part of the liver lobule in a patient with disulfiram induced liver injury.

Figure 3. Hepatic eosinophilia in another patient with disulfiram induced liver injury.