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To The Editor: The expert opinion meeting report on drug-induced autoimmune-like hepatitis (DI-ALH) by Andrade et al1 highlights the continuing challenge of diagnosing DI-ALH and differentiating it from" idiopathic" classic AIH (cAIH). As reiterated by the authors, this distinction is vital as cAIH requires long term immunosuppression whereas DI-ALH responds to withdrawal of the drug in most cases; some cases may require low dose steroids that can be tapered off in a few weeks.

The presence of moderate to severe interface hepatitis constitutes a key diagnostic criterion for diagnosis of cAIH, and therefore liver biopsies are always performed in patients with cAIH2, 3. Similarly, although not required for diagnosis, liver biopsies may be performed in cases of drug induced liver injury, including DI-ALH to either confirm the diagnosis and/or rule out concomitant processes. When a liver biopsy is performed, there is …