Drug-Induced Fatty Liver Disease

Abstract

Drug-induced fatty liver disease (DIFLD) is one of the manifestations of drug-induced liver injury (DILI) based on histopathology findings of steatosis or steatohepatitis. DIFLD has high semblance to nonalcoholic fatty liver disease (NAFLD), where similar histopathological features are seen. As NAFLD is a commonly occurring disease, differentiating DIFLD from NAFLD requires a thorough history of medication use. Outcomes in DIFLD vary with the clinical presentation, with extremely high mortality in acute fatty liver presentations and indolent course in the rest. Pathophysiology in almost all cases of DIFLD encompasses one of the following: increased uptake or decreased output of triglycerides from hepatocytes or decreased metabolism of triglycerides (such as fatty acid oxidation) or electron transport chain. DIFLD may present as acute fatty liver or more commonly as indolent fatty liver disease. In this article, we outline pathophysiology, diagnosis, management, and common medications associated with DIFLD. Recent findings give insights into new technologies that may help us understand common pathways that are associated with drugs that cause and factors that modify susceptibility to DIFLD. Latest research has also allowed for identification of genetic polymorphisms associated with increased risk for DIFLD using genome-wide association studies (GWAS). Drugs associated with DIFLD may have distinct clinical presentations, disease progression, and outcomes, timely identification of which is crucial to clinical management. We provide a succinct read for anyone interested in DIFLD phenotype of DILI, pathophysiology, clinical presentation, and management.