• Yue-Ming Shao, Yu Zhang, Xin Yin, Ting-Ting Qin, Qing-Long Jin, and Xiao-Yu Wen.
• Department of Hepatology, The First Hospital of Jilin University.
• Medicine (Baltimore). 2021 Jan 15; 100 (2): e24045.

RationaleDrug-induced liver injury (DILI) has a relatively low incidence, whereas the incidence of herb-induced liver injury (HILI) is still under investigation. As a special type of DILI, the diagnosis of drug-induced autoimmune-like hepatitis presents a persistent challenge, because this condition has partial characteristics of both DILI and autoimmune hepatitis (AIH), such as a certain history of medication use and histology that similar is to AIH. Thus, the differential diagnosis between DILI and AIH can be confusing.Patient ConcernsA 67-year-old woman taking xiang-tian-guo for 6 months was admitted to our hospital with a complaint of experiencing jaundice for 2 weeks.DiagnosisA liver biopsy exhibited interface inflammation, foam cells, and "rosette" -like hepatocytes. She was diagnosed with herb-induced liver injury (hepatocellular and acute), a RUCAM score of 7 (probable), a severity for grade 4 liver injury, and accompanied autoimmune-like changes.InterventionsThe patient was instructed to cease the administration of suspicious drugs. The patient also received liver protection and albumin transfusion.OutcomesAfter 25 days of hospitalization, the patients aminotransferase levels returned to normal. No recurrence was observed after the administration of the treatments and a close follow-up.LessonsWe must to be vigilant about the safety of xiang-tian-guo as a herbal medicine. When faced with the difficulty of distinguishing between AIH and DILI, long-term follow-up observations for recurrence can aid clinicians in making a judgment.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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