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Type of Lesion

Examples

Comments

Acute viral hepatitis-like reaction

Diclofenac, halothane, isoflurane, isoniazid, methyldopa, phenytoin

Mortality rate much higher than that of viral hepatitis; histologic pattern of bridging necrosis in severe cases

Zonal necrosis

Acetaminophen, carbon tetrachloride

Dose dependent; negligible inflammatory response; lesions predominantly restricted to one lobular zone

Steatohepatitis, alcoholic hepatitis-like reaction

Amiodarone, perhexiline, nifedipine, valproic acid

Steatohepatitis, microvesicular

Aspirin, tetracycline, zidovudine

Cholestasis

Angiotensin-converting enzyme inhibitors, carbamazepine, chlorpromazine, cimetidine, cotrimoxazole, dextropropoxyphene, erythromycin, estrogens, flucloxacillin, haloperidol, sulfonamides, tricyclic antidepressants

Histologically, inflammatory, noninflammatory, and forms with bile duct destruction can be recognized

Granulomatous hepatitis

Allopurinol, diltiazem, quinidine, phenytoin, procainamide, sulfonamides

Histiocytes and eosinophiles in the granulomas reflect a hypersensitivity reaction

Veno-occlusive disease

Chemotherapeutic drugs

Lesions are dose dependent

Chronic hepatitis

Amiodarone, aspirin, diclofenac, isoniazid, methyldopa, phenytoin, nitrofurantoin, trazodone

Occurs with continued exposure to a drug; in most cases, hepatitis resolves after discontinuation of the drug

Adenomas, hepatocellular carcinomas

Estrogens, anabolic hormones