{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T03:47:12Z","timestamp":1784260032841,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T00:00:00Z","timestamp":1659052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Drug-induced liver injury (DILI) is uncommon but potentially lethal. Over 6 years, 2533 children with acute liver disease were identified in our center, 48 of which suffered from toxic hepatitis, and 40 exhibited DILI (22 paracetamol-related, 14 albendazole-related). The most affected children were in the 13\u201317-year-old age group. The mean time between drug ingestion and disease diagnosis was 25.4 h for paracetamol-related DILI and 21.6 days for the albendazole-related group. Clinical features were mostly gastrointestinal, jaundice being reported in 30% of the cases. Regarding the type of liver injury, for 70% of the patients it was hepatocellular (mostly paracetamol toxicity), for 11% cholestatic, and for 19% mixed (albendazole-related). The mean initial ALT value was 1020 U\/L for all DILIs. Coagulopathy was only identified for the acetaminophen-related group. The median number of hospitalization days was 6.9 for DILI related to acetaminophen ingestion, compared with 7 for the idiosyncratic pattern. When applying the DILI severity index, 81% of the patients were categorized as having a mild hepatic ailment, while 19% had a moderate\u2013severe or severe disease. No deaths were reported in the study group. The diagnosis of DILI involves the exclusion of other causes of liver injury; therefore, it is considered one of the most challenging diagnoses in hepatology.<\/jats:p>","DOI":"10.3390\/children9081136","type":"journal-article","created":{"date-parts":[[2022,7,31]],"date-time":"2022-07-31T21:49:02Z","timestamp":1659304142000},"page":"1136","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Drug-Induced Hepatitis in Children: The Experience of a Single Center in Romania"],"prefix":"10.3390","volume":"9","author":[{"given":"Irina","family":"Dijm\u0103rescu","sequence":"first","affiliation":[{"name":"Department of Pediatrics, \u201cGrigore Alexandrecu\u201d Emergency Children\u2019s Hospital, 011743 Bucharest, Romania"},{"name":"Department of Pediatrics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Maria","family":"Gu\u021b\u0103","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cGrigore Alexandrecu\u201d Emergency Children\u2019s Hospital, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia Elena","family":"Brezeanu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cGrigore Alexandrecu\u201d Emergency Children\u2019s Hospital, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian Dumitru","family":"Dijm\u0103rescu","sequence":"additional","affiliation":[{"name":"Radiology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Adriana","family":"Becheanu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cGrigore Alexandrecu\u201d Emergency Children\u2019s Hospital, 011743 Bucharest, Romania"},{"name":"Department of Pediatrics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"P\u0103curar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cGrigore Alexandrecu\u201d Emergency Children\u2019s Hospital, 011743 Bucharest, Romania"},{"name":"Department of Pediatrics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2019). EASL Clinical Practice Guidelines: Drug-induced liver injury. J. Hepatol., 70, 1222\u20131261.","DOI":"10.1016\/j.jhep.2019.02.014"},{"key":"ref_2","unstructured":"Council for International Organizations of Medical Sciences (CIOMS) (2020). Drug-induced liver injury (DILI): Current status and future directions for drug development and the post-market setting. A Consensus by a CIOMS Working Group, Council for International Organizations of Medical Sciences (CIOMS)."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100321","DOI":"10.1016\/j.aohep.2021.100321","article-title":"Drug-induced liver injury: A management position paper from the Latin American Association for Study of the liver-Paper Position","volume":"24","author":"Bessone","year":"2021","journal-title":"Ann. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1038\/clpt.2011.58","article-title":"Case definition and phenotype standardization in drug-induced liver injury","volume":"89","author":"Aithal","year":"2011","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_5","unstructured":"(2022, March 16). Clinical Manifestations and Diagnosis of Acetaminophen (Paracetamol) Poisoning in Children and Adolescents. Available online: https:\/\/www.uptodate.com\/contents\/clinical-manifestations-and-diagnosis-of-acetaminophen-paracetamol-poisoning-in-children-and-adolescents."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.redox.2018.04.019","article-title":"Mechanisms of acetaminophen-induced liver injury and its implications for therapeutic interventions","volume":"17","author":"Yan","year":"2018","journal-title":"Redox Biol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S0001-706X(03)00031-7","article-title":"Albendazole, mebendazole and praziquantel. Review of non-clinical toxicity and pharmacokinetics","volume":"86","author":"Dayan","year":"2003","journal-title":"Acta Trop."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"621","DOI":"10.2133\/dmpk.DMPK-12-RG-019","article-title":"Stimulation of human monocytic THP-1 cells by metabolic activation of hepatotoxic drugs","volume":"27","author":"Endo","year":"2012","journal-title":"Drug Metab. Pharmacokinet."},{"key":"ref_9","unstructured":"Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (2022, April 04). Roussel Uclaf Causality Assessment Method (RUCAM) in Drug Induced Liver Injury, LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK548272\/."},{"key":"ref_10","unstructured":"Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (2022, April 04). Severity Grading in Drug Induced Liver Injury, LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK548241\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1002\/hep.23696","article-title":"Andrade Standardization of Nomenclature and Causality Assessment in Drug-Induced Liver Injury: Summary of a Clinical Research","volume":"52","author":"Fontana","year":"2010","journal-title":"Hepatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"55","DOI":"10.2165\/00002018-200932010-00005","article-title":"Rationale, design and conduct of the Drug Induced Liver Injury Network prospective study","volume":"32","author":"Fontana","year":"2009","journal-title":"Drug Saf."},{"key":"ref_13","first-page":"122","article-title":"DILI\u2014Drug Induced liver injury in 2017: The diagnosis is not easy, but always to keep in mind","volume":"21","author":"Marrone","year":"2017","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_14","first-page":"A2132","article-title":"Intentional paracetamol intoxication in children","volume":"155","author":"Bisschops","year":"2011","journal-title":"Ned. Tijdschr. Geneeskd."},{"key":"ref_15","first-page":"681","article-title":"Frequently used drug types and alcohol involvement in intentional drug overdoses in Ireland: A national registry study","volume":"28","author":"Daly","year":"2018","journal-title":"Eur. J. Public Health"},{"key":"ref_16","unstructured":"(2022, January 05). Acetaminophen (Paracetamol): Drug Information. Available online: https:\/\/www.uptodate.com\/contents\/acetaminophen-paracetamol-drug-information."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1080\/17474124.2021.1857238","article-title":"Biomarkers of drug-induced liver injury: A mechanistic perspective through acetaminophen hepatotoxicity","volume":"15","author":"Umbaugh","year":"2021","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_18","first-page":"396","article-title":"Favourable results for L-carnitine use in valproic acid acute poisoning","volume":"65","author":"Tincu","year":"2017","journal-title":"Farmacia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1097\/MPG.0b013e31821d6cfd","article-title":"Characteristics of Idiosyncratic Drug-induced Liver Injury in Children: Results from the DILIN Prospective Study","volume":"53","author":"Molleston","year":"2011","journal-title":"Pediatr. Gastroenterol. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"903","DOI":"10.3346\/jkms.2008.23.5.903","article-title":"Acute drug-induced hepatitis caused by albendazole","volume":"23","author":"Choi","year":"2008","journal-title":"J. Korean Med. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"118","DOI":"10.25100\/cm.v44i2.1021","article-title":"Albendazole-induced liver injury: A case report","volume":"44","author":"Rios","year":"2013","journal-title":"Colomb. Med."},{"key":"ref_22","unstructured":"Magill, A.J., Ryan, E.T., Hill, D., and Solomon, T. (2013). Hunter\u2019s Tropical Medicine and Emerging Infectious Diseases, Elsevier Saunders. [9th ed.]."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/1752-1947-7-201","article-title":"Albendazole-induced granulomatous hepatitis: A case report","volume":"7","year":"2013","journal-title":"J. Med. Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Danan, G., and Teschke, R. (2015). RUCAM in Drug and Herb-induced Liver Injury: The Update. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17010014"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4323\/rjlm.2017.279","article-title":"The use of 3D printing in improving patient-doctor relationship and malpractice prevention","volume":"25","author":"Tevanov","year":"2017","journal-title":"Romanian J. Leg. Med."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/8\/1136\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:58:55Z","timestamp":1760140735000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/8\/1136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,29]]},"references-count":25,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["children9081136"],"URL":"https:\/\/doi.org\/10.3390\/children9081136","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,29]]}}}