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Drug-Induced Autoimmune Hepatitis — RACP Adult Medicine MCQ

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HardGastroenterologyDrug-Induced Autoimmune HepatitisRACP Adult Medicine

A 35-year-old woman on minocycline for acne for 18 months develops fatigue and elevated transaminases. ANA is positive (1:320) and IgG is elevated (22 g/L). Liver biopsy shows interface hepatitis with plasma cell infiltration, indistinguishable from idiopathic AIH. What is the most likely hepatotoxicity pattern?

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Correct answer: A — Drug-induced autoimmune hepatitis

Minocycline-induced autoimmune hepatitis presents with positive ANA, elevated IgG, and biopsy indistinguishable from idiopathic AIH. Key distinguishing feature: resolution after drug withdrawal (may take weeks-months). Other drugs causing DI-AIH include nitrofurantoin, methyldopa, and statins. Corticosteroids may be needed for bridging. Relapse on rechallenge confirms the diagnosis.

Reference: EASL – 2025 – AIH Guidelines; AASLD 2024 DILI