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We aim to expand the knowledge on the spectrum of phenotypes and outcomes of<jats:styled-content style=\"fixed-case\">CPA<\/jats:styled-content>\u2010induced<jats:styled-content style=\"fixed-case\">DILI<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty\u2010two males (70\u00a0\u00b1\u00a08 years; range 54\u201383) developing liver damage as a result of<jats:styled-content style=\"fixed-case\">CPA<\/jats:styled-content>therapy (dose: 150\u00a0\u00b1\u00a050\u00a0mg\/day; range 50\u2013200) were included. Severity index and causality by<jats:styled-content style=\"fixed-case\">RUCAM<\/jats:styled-content>were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 1993 to 2013, 22 patients were retrieved. Latency was 163\u00a0\u00b1\u00a097\u00a0days. Most patients were symptomatic, showing hepatocellular injury (91%) and jaundice. Liver tests at onset were:<jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content>18\u00a0\u00b1\u00a013\u00a0\u00d7\u00a0<jats:styled-content style=\"fixed-case\">ULN<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\">ALP<\/jats:styled-content>0.7\u00a0\u00b1\u00a00.7\u00a0\u00d7\u00a0<jats:styled-content style=\"fixed-case\">ULN<\/jats:styled-content>and total serum bilirubin 14\u00a0\u00b1\u00a010\u00a0mg\/dl. International normalized ratio values higher than 1.5 were observed in 14 (66%) patients. Severity was mild in 1 case (4%), moderate in 7 (32%), severe in 11 (50%) and fatal in 3 (14%). Five patients developed ascitis, and four encephalopathy. One patient had a liver injury that resembled autoimmune hepatitis. Eleven (50%) were hospitalized. Nineteen patients recovered after<jats:styled-content style=\"fixed-case\">CPA<\/jats:styled-content>withdrawal, although three required steroid therapy (two of them had high<jats:styled-content style=\"fixed-case\">ANA<\/jats:styled-content>titres). Liver biopsy was performed in seven patients (two hepatocellular collapse, one submassive necrosis, two cholestatic hepatitis, one cirrhosis with iron overload and one autoimmune hepatitis).<jats:styled-content style=\"fixed-case\">RUCAM<\/jats:styled-content>category was \u2018highly probable\u2019 in 19 (86%), \u2018probable\u2019 in 1 (4%), and \u2018possible\u2019 in 2 (9%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">CPA<\/jats:styled-content>\u2010induced liver injury is severe and can be fatal, and may occasionally resemble autoimmune<jats:styled-content style=\"fixed-case\">DILI<\/jats:styled-content>. The benefit\/risk ratio of this drug should be thoroughly assessed in each patient.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.12899","type":"journal-article","created":{"date-parts":[[2015,6,23]],"date-time":"2015-06-23T04:57:38Z","timestamp":1435035458000},"page":"302-310","source":"Crossref","is-referenced-by-count":52,"title":["Cyproterone acetate induces a wide spectrum of acute liver damage including corticosteroid\u2010responsive hepatitis: report of 22 cases"],"prefix":"10.1111","volume":"36","author":[{"given":"Fernando","family":"Bessone","sequence":"first","affiliation":[{"name":"Servicio de Gastroenterolog\u00eda y Hepatolog\u00eda Facultad de Ciencias M\u00e9dicas Universidad Nacional de Rosario Rosario Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MI","family":"Lucena","sequence":"additional","affiliation":[{"name":"Unidad de Hepatolog\u00eda y Servicio de Farmacolog\u00eda Cl\u00ednica Instituto de Investigaci\u00f3n Biom\u00e9dica de 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