Current Hepatology Reports

, Volume 18, Issue 3, pp 269–273 | Cite as

Bile Duct Injury Due to Drug-Induced Liver Injury

  • Priya Grewal
  • Jawad AhmadEmail author
Drug-Induced Liver Injury (P Hayashi, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Drug-Induced Liver Injury


Purpose of Review

Drug-induced liver injury (DILI) can present with a variable clinical and pathological phenotype and can be classified using liver enzymes as hepatocellular, cholestatic, or a mixed pattern. The cholestatic pattern has been considered amongst the spectrum of direct liver damage at the microscopic level, but recently, bile duct injury, as a manifestation of DILI, has emerged as a distinct entity, and this review examines several examples of biliary tract abnormalities due to DILI from a clinical, radiologic, and pathologic perspective.

Recent Findings

Case series and reports have emerged over the last few years of drugs causing cholangiographic changes or direct injury to the intra- and extra-hepatic biliary tree, such as ketamine and several chemotherapy agents. The DILI Network (DILIN) in the USA has published their experience of cases with vanishing bile duct syndrome on histology and sclerosing cholangitis-like changes seen on cholangiography. The pathogenesis of these changes is unclear but it appears that this type of injury is more severe and more likely to lead to a chronic injury with increased mortality than other cases of DILI.


Bile duct injury due to DILI is an increasingly recognized entity and imaging of the biliary tree in conjunction with liver biopsy should be considered in patients with severe cholestatic DILI.


Drug-induced liver injury (DILI) Cholangitis 



Alanine aminotransferase

Alk P

Alkaline phosphatase


Aspartate aminotransferase


Drug-induced liver injury


Drug-Induced Liver Injury Network


Magnetic resonance cholangiopancreatography


Sclerosing cholangitis


Vanishing bile duct syndrome


Author Contributions

All authors contributed to the collection of clinical data, data analysis, and initial and final drafting of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

Priya Grewal and Jawad Ahmad each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkUSA

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