• Sclerosing duct injury: Fibrosis affecting large bile ducts similar to primary sclerosing cholangitis (PSC)
5-fluorodeoxyuridine (intraarterial infusion for metastatic colorectal carcinoma), formaldehyde, and sodium chloride (injected into hydatid cysts)
Top Differential Diagnoses
• Pure cholestasis: Sepsis, shock, benign recurrent intrahepatic cholestasis
• Cholestatic hepatitis: Other causes of hepatitis (viral, autoimmune, Wilson disease)
• Obstructive biliary disease
• Prolonged cholestasis/ductopenia: Primary biliary cholangitis and PSC
Obstruction-Like Features Portal edema, inflammation, and bile ductular reaction in drug-induced liver injury (DILI) may be indistinguishable from obstructive biliary disease on histologic grounds.
Cholestatic Hepatitis Cholestasis is accompanied by hepatitic features evidenced by lobular inflammation and hepatocellular dropout . This is the most common histologic pattern observed in DILI.
Pure Cholestasis This pattern, also known as bland cholestasis, is characterized by bile in hepatocytes and canaliculi with no significant hepatocellular injury or inflammation. The portal tracts and interlobular bile ducts are normal and ductular reaction is not present in this pattern.
Prolonged Cholestasis Arteriole without interlobular bile duct indicates bile duct loss . Swelling of periportal hepatocytes is present (cholate stasis), a feature of prolonged cholestasis.