Drug-Induced Liver Injury in Children

Abstract

Drug-induced liver injury (DILI) is relatively rare among children but can cause substantial morbidity and mortality. Here, we summarize the literature on pediatric DILI including a focus on commonly used classes of drugs. The incidence of pediatric DILI remains poorly defined. Antimicrobials and antiepileptic medications are the most commonly reported causes of pediatric idiosyncratic DILI in the US DILI network (DILIN) experience. DILI among children being treated for cancer appears to be underreported, and recent literature clearly implicates newer classes of agents such as tumor necrosis factor-α inhibitors as potentially hepatotoxic. Many drugs trigger signature patterns of DILI; autoimmune hepatitis secondary to minocycline is an example. DILI should be suspected whenever a child presents with evidence of liver injury. Familiarity with established patterns of DILI secondary to specific agents can facilitate recognition of cases. Active reporting of cases by clinicians to registries such as US DILIN remains critical to a continuing understanding of the causes and risk factors of DILI among children.