Drug-induced Liver Injury is Frequently Associated with Severe Cutaneous Adverse Drug Reactions: Experience from Two Australian Tertiary Hospitals

Wendy C Fang, Nikki Adler, Linda V Graudins, Caitlin Goldblatt, Michelle SY Goh, Stuart K Roberts, Jason Anthony Trubiano, Ar Kar Aung

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Drug‐induced liver injury can be associated with certain cutaneous adverse drug reactions.

We aim to demonstrate the prevalence of drug‐induced liver injury in patients with cutaneous adverse drug reactions. Severity and patterns of liver injury, risk factors, causal medications and outcomes are also examined.

A retrospective cohort study of patients with cutaneous adverse drug reactions was conducted across two hospitals in Australia. Patients were identified through cross‐linkage of multiple databases.

104 patients with cutaneous adverse drug reactions were identified. Of these, 33 (31.7%) had liver injury, representing 50% of patients with drug reaction with eosinophilia and systemic symptoms, and 30.2% of patients with Stevens‐Johnson syndrome/toxic epidermal necrolysis. Most cases of liver injury (69.7%) were of a cholestatic/mixed pattern with severe disease in 18.2%. No significant risk factors for development of liver injury were noted, but peripheral lymphocytosis may represent a risk in patients with Stevens‐Johnson syndrome (OR=6.0, 95% CI:1.8–19.7, p=0.003). Antimicrobials were the most common class to be implicated in drug‐induced liver injury. The median length of inpatient stay was longer in patients with liver injury compared to those without (19 vs. 11 days, p=0.002). The mortality rate in those with liver injury was 15.2% and 9.9% in those without. No patients required liver transplantation.

Drug‐induced liver injury commonly occurs in patients with cutaneous adverse drug reactions and is associated with longer inpatient stay. Patients with Stevens‐Johnson/toxic epidermal necrolysis and peripheral lymphocytosis appear to be at higher risk for developing associated liver injury.
Original languageEnglish
Pages (from-to)549-555
Number of pages7
JournalInternal Medicine Journal
Issue number5
Publication statusPublished - May 2018


  • drug induced liver injury
  • Stevens Johnson syndrome
  • drug reaction with eosinophilia and systemic symptoms
  • drug hypersensitivity syndrome
  • adverse drug reaction

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