{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:16:02Z","timestamp":1789690562491,"version":"4.0.1"},"reference-count":85,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T00:00:00Z","timestamp":1713398400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>The incidence and prevalence of drug-induced liver injury appear to be increasing globally, for example, with the introduction of checkpoint inhibitors. Several reviews have been published in the last decade on the epidemiology of DILI, both among hospitalized patients and in the general population, as well as from retrospective and prospective studies on DILI. Most of these reviews have not focused on newly recognized agents that have recently changed the landscape of DILI. Apart from liver injury associated with antibiotics, oncological agents, particularly checkpoint inhibitors, are increasingly being recognized as causing liver injury. The type of liver injury associated with these agents is not idiosyncratic but rather an indirect type of injury. Furthermore, recently, COVID-19 vaccines and green tea extract have been found to lead to liver injury. Checkpoint inhibitors have revolutionized the treatment of many malignancies, such as malignant melanoma, lung cancer, and renal cancer. Via the activation of T cells, they can increase immune activity against malignant cells, but at the same time, they can decrease immune tolerance and therefore lead to immune-related adverse effects in many organs. The most common adverse effect in clinical practice is liver injury. A recent prospective study demonstrated an 8% frequency of DILI due to the use of checkpoint inhibitors among patients with malignant melanoma and renal cancer. This rate is much higher than observed with drugs, leading to idiosyncratic liver injury. Shortly after the implementation of the worldwide vaccination program against COVID-19, several case reports were published on suspected vaccination-induced autoimmune-like hepatitis occurring shortly after the vaccination. At first, these reports were met with skepticism, but currently, around 100 reports have been published, and cases of positive recurrence have been reported. The clinical, biochemical, immunological, and histological features are indistinguishable from classic autoimmune hepatitis (AIH). These reactions are very similar to drug-induced autoimmune-like hepatitis (DI-ALH) due to drugs such as nitrofurantoin, minocycline, and infliximab, which do not relapse after a short course of corticosteroids, which is the general rule in classic autoimmune hepatitis (AIH). Green tea extract has been found to be a well-documented cause of acute hepatocellular liver injury with jaundice. A strong HLA association has been reported, showing a high prevalence of HLA-B*35:01 among patients suffering from green tea-induced liver injury. Overall, 3% of patients recruited in the DILIN study were supplemented with green tea extract as one of the ingredients. In a prospective population-based study from Iceland, green tea was implicated in approximately 8% of patients with DILI.<\/jats:p>","DOI":"10.3390\/ph17040520","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T07:55:54Z","timestamp":1713426954000},"page":"520","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["The Epidemiology of Newly Recognized Causes of Drug-Induced Liver Injury: An Update"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8392-0632","authenticated-orcid":false,"given":"Einar Stefan","family":"Bj\u00f6rnsson","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, The National University Hospital of Iceland, Faculty of Medicine, University of Iceland, Hringbraut, 101 Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/liv.15821","article-title":"Anticancer drugs are the first cause of drug-induced liver injury in a reference hospital","volume":"44","author":"Pocurull","year":"2024","journal-title":"Liver Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/liv.15378","article-title":"A new framework for advancing in drug-induced liver injury research. The Prospective European DILI Registry","volume":"43","author":"Stephens","year":"2023","journal-title":"Liver Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.cld.2016.08.004","article-title":"Epidemiology and Genetic Risk Factors of Drug Hepatotoxicity","volume":"21","author":"Ahmad","year":"2017","journal-title":"Clin. Liver Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1007\/s11901-019-00475-z","article-title":"Global epidemiology of drug-induced liver injury (DILI)","volume":"18","author":"Bjornsson","year":"2019","journal-title":"Curr. Hepatol. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cld.2019.08.002","article-title":"Epidemiology, predisposing factors and outcome in DILI","volume":"24","author":"Bjornsson","year":"2020","journal-title":"Clin. Liver Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1111\/liv.15262","article-title":"Incidence and risk factors of drug-induced liver injury","volume":"42","author":"Li","year":"2022","journal-title":"Liver Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1002\/j.1875-9114.1992.tb04511.x","article-title":"Liver disease associated with diclofenac, naproxen, and piroxicam","volume":"12","author":"Jick","year":"1992","journal-title":"Pharmacotherapy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1001\/archinte.1994.00420030117012","article-title":"Acute liver injury associated with nonsteroidal anti-inflammatory drugs and the role of risk factors","volume":"154","author":"Williams","year":"1994","journal-title":"Arch. Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1001\/archinte.1996.00440110099013","article-title":"Risk of acute liver injury associated with the combination of amoxicillin and clavulanic acid","volume":"156","author":"Stricker","year":"1996","journal-title":"Arch. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1053\/jhep.2002.34857","article-title":"Incidence of drug-induced hepatic injuries: A French population-based study","volume":"36","author":"Sgro","year":"2002","journal-title":"Hepatology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1053\/j.gastro.2013.02.006","article-title":"Incidence, Presentation and Outcomes in Patients with Drug-Induced Liver Injury in the General Population of Iceland","volume":"144","author":"Bjornsson","year":"2013","journal-title":"Gastroenterology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1007\/s40264-017-0547-9","article-title":"The incidence of drug- and herbal and dietary supplement- induced liver injury: Preliminary findings from gastroenterologist-based surveillance in the population of the state of Delaware","volume":"40","author":"Vega","year":"2017","journal-title":"Drug Saf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2230","DOI":"10.1053\/j.gastro.2019.02.002","article-title":"Incidence and Etiology of Drug-Induced Liver Injury in Mainland China","volume":"156","author":"Shen","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1053\/j.gastro.2019.06.045","article-title":"Letter to the Editor: Response to the article \u201cIncidence and Etiology of Drug-Induced Liver Injury in Mainland China\u201d","volume":"157","author":"Devarbhavi","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1046\/j.1365-2125.2000.00282.x","article-title":"Detection and incidence of drug-induced liver injuries in hospital: A prospective analysis from laboratory signals","volume":"50","author":"Bagheri","year":"2000","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s00228-004-0888-z","article-title":"Incidence of drug-induced liver injury in medical inpatients","volume":"61","author":"Meier","year":"2005","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/j.1365-2125.2004.02133.x","article-title":"Acute and clinically relevant drug-induced liver injury: A population based case-control study","volume":"58","author":"Montero","year":"2004","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1038\/ajg.2012.138","article-title":"A prospective nationwide study of drug-induced liver injury in Korea","volume":"107","author":"Suk","year":"2012","journal-title":"Am. J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1111\/j.1478-3231.2007.01461.x","article-title":"Drug-induced liver injury at an Asian center: A prospective study","volume":"27","author":"Wai","year":"2007","journal-title":"Liver Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e548","DOI":"10.1016\/j.cgh.2021.01.011","article-title":"Herbal and dietary supplements-induced liver injury in Latin America: Experience from the LATINDILI network","volume":"20","author":"Bessone","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1111\/j.1365-2036.2006.03117.x","article-title":"Drug-induced liver injury in a Swedish University hospital outpatient hepatology clinic","volume":"24","author":"Klinteberg","year":"2006","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1038\/ajg.2010.287","article-title":"Single-center experience with drug-induced liver injury from India: Causes, outcome, prognosis and predictors of mortality","volume":"105","author":"Devarbhavi","year":"2010","journal-title":"Am. J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1056\/NEJMoa1504030","article-title":"Combined nivolumab and ipilimumab or monotherapy in untreated melanoma","volume":"373","author":"Larkin","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1056\/NEJMra1816149","article-title":"Drug Induced Liver Injury: Types and Phenotypes","volume":"381","author":"Hoofnagle","year":"2019","journal-title":"N. Eng. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3815","DOI":"10.1200\/JCO.2016.72.1167","article-title":"Pooled analysis safety profile of nivolumab and ipilimumab combination therapy in patients with advanced melanoma","volume":"35","author":"Sznol","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1056\/NEJMoa1709684","article-title":"Overall survival with combined nivolumab and ipilimumab in advanced melanoma","volume":"377","author":"Wolchok","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1111\/liv.13746","article-title":"Hepatotoxicity of immune checkpoint inhibitors: An evolving picture of risk associated with a vital class of immunotherapy agents","volume":"38","author":"Suzman","year":"2018","journal-title":"Liver Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.jhep.2018.01.033","article-title":"Characterization of liver injury induced by cancer immunotherapy using immune checkpoint inhibitors","volume":"68","author":"Michot","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"251","DOI":"10.14309\/ajg.0000000000000398","article-title":"Clinical Characteristics and Adverse Impact of Hepatotoxicity due to Immune Checkpoint Inhibitors","volume":"115","author":"Miller","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"101491","DOI":"10.1016\/j.clinre.2020.06.016","article-title":"Severe immune-related hepatitis induced by immune checkpoint inhibitors: Clinical features and management proposal","volume":"45","author":"Gauci","year":"2021","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Malnick, S.D.H., Abdullah, A., and Neuman, M.G. (2021). Checkpoint inhibitors and hepatotoxicity. Biomedicines, 9.","DOI":"10.3390\/biomedicines9020101"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1007\/s12072-021-10151-4","article-title":"Checkpoint inhibitor induced hepatitis and the relation with liver metastasis and outcome in advanced melanoma patients","volume":"15","author":"Biewenga","year":"2021","journal-title":"Hepatol. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/jcag\/gwab019","article-title":"Clinical Course and Treatment Implications of Combination Immune Checkpoint Inhibitor-Mediated Hepatitis: A Multicentre Cohort","volume":"5","author":"Smith","year":"2021","journal-title":"J. Can. Assoc. Gastroenterol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e0063","DOI":"10.1097\/HC9.0000000000000063","article-title":"Hepatotoxicity of immune checkpoint inhibitors: What is Currently Known","volume":"7","author":"Zheng","year":"2023","journal-title":"Hepatol. Commun."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1002\/ijc.32132","article-title":"A systematic review of adverse events in randomized trials assessing immune checkpoint inhibitors","volume":"145","author":"Maillet","year":"2019","journal-title":"Int. J. Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1111\/apt.15413","article-title":"Liver injury is most commonly due to hepatic metastases rather than drug hepatotoxicity during pembrolizumab immunotherapy","volume":"50","author":"Tsung","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"100851","DOI":"10.1016\/j.jhepr.2023.100851","article-title":"Incidence, risk factors and outcomes of checkpoint inhibitor-induced liver injury: A 10-year real-world retrospective cohort study","volume":"5","author":"Atallah","year":"2023","journal-title":"JHEP Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/0895-4356(93)90101-6","article-title":"Causality assessment of adverse reactions to drugs-I. A novel method based on the conclusions of international consensus meetings: Application to drug-induced liver injuries","volume":"46","author":"Danan","year":"1993","journal-title":"J. Clin. Epidemiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1111\/liv.15687","article-title":"The importance of prospective drug-induced liver injury registries","volume":"43","author":"Trinh","year":"2023","journal-title":"Liver Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.jhep.2021.04.003","article-title":"Autoimmune hepatitis developing after coronavirus disease 2019 (COVID-19) vaccine: Causality or casualty?","volume":"75","author":"Bril","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"102710","DOI":"10.1016\/j.jaut.2021.102710","article-title":"Autoimmune hepatitis triggered by SARS-CoV-2 vaccination","volume":"123","author":"Montani","year":"2021","journal-title":"J. Autoimmun."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"102741","DOI":"10.1016\/j.jaut.2021.102741","article-title":"Autoimmune hepatitis after COVID-19 vaccine\u2014More than a coincidence","volume":"125","author":"Garrido","year":"2021","journal-title":"J. Autoimmun."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.jhep.2021.05.038","article-title":"Autoimmune hepatitis following SARS-CoV-2 vaccine: May not be a casuality","volume":"75","author":"Rocco","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.jhep.2021.04.039","article-title":"Comment on \u201cAutoimmune hepatitis developing after coronavirus disease 2019 (COVID-19) Vaccine: Causality or casualty?\u201d","volume":"75","author":"Capecchi","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"102745","DOI":"10.1016\/j.jaut.2021.102745","article-title":"Autoimmune hepatitis after SARSCoV-2 vaccine: New-onset or flare-up?","volume":"125","author":"Avci","year":"2021","journal-title":"J. Autoimmun."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1016\/j.jhep.2021.06.004","article-title":"Another case of autoimmune hepatitis after SARS-CoV-2 vaccination\u2014Still casualty?","volume":"75","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1016\/j.jhep.2021.06.014","article-title":"Autoimmune hepatitis developing after the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine","volume":"75","author":"Schneider","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1016\/j.jhep.2021.06.009","article-title":"Autoimmune hepatitis following COVID-19 vaccination: True causality or mere association?","volume":"75","author":"Tan","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e116","DOI":"10.3346\/jkms.2022.37.e116","article-title":"Autoimmune Hepatitis Following Vaccination for SARS-CoV-2 in Korea: Coincidence or Autoimmunity?","volume":"37","author":"Kang","year":"2022","journal-title":"J. Korean Med. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1016\/j.jhep.2021.07.005","article-title":"An unusual case of acute cholestatic hepatitis after m-RNABNT162b2 (Comirnaty) SARS-CoV-2 vaccine: Coincidence, autoimmunity or drug-related liver injury","volume":"75","author":"Lodato","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"102706","DOI":"10.1016\/j.jaut.2021.102706","article-title":"Acute autoimmune-like hepatitis with atypical anti-mitochondrial antibody after mRNA COVID-19 vaccination: A novel clinical entity?","volume":"123","author":"Ghielmetti","year":"2021","journal-title":"J. Autoimmun."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1016\/j.jhep.2021.06.044","article-title":"The mRNA COVID-19 vaccine\u2014A rare trigger of autoimmune hepatitis?","volume":"75","author":"McShane","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"101600","DOI":"10.1016\/j.trim.2022.101600","article-title":"First report of post-transplant autoimmune hepatitis recurrence following SARS-CoV-2 mRNA vaccination","volume":"72","author":"Mahalingham","year":"2022","journal-title":"Transpl. Immunol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.jhep.2022.03.040","article-title":"SARS-CoV-2 vaccination can elicit a CD8 T-cell dominant hepatitis","volume":"77","author":"Boettler","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.jhep.2021.07.024","article-title":"Liver injury following SARS-CoV-2 vaccination: A multicenter case series","volume":"76","author":"Shroff","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/hep.32156","article-title":"Letter to the editor: Autoimmune hepatitis after COVID-19 vaccination: A rare adverse effect?","volume":"75","author":"Palla","year":"2022","journal-title":"Hepatology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.jhep.2021.09.031","article-title":"Immune mediated hepatitis with the Moderna vaccine, no longer a coincidence but confirmed","volume":"76","author":"Gleeson","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1002\/hep.32269","article-title":"Letter to the editor: Exacerbation of autoimmune hepatitis after COVID-19 vaccination","volume":"75","author":"Cao","year":"2022","journal-title":"Hepatology"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1002\/hep.32280","article-title":"Letter to the editor: Autoimmune hepatitis after COVID-19 vaccination: Need for population-based epidemiological study","volume":"75","author":"Suzuki","year":"2022","journal-title":"Hepatology"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1002\/hep.32572","article-title":"Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome","volume":"76","author":"Efe","year":"2022","journal-title":"Hepatology"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"100605","DOI":"10.1016\/j.jhepr.2022.100605","article-title":"Histological and serological features of acute liver injury after SARS-CoV-2 vaccination","volume":"5","author":"Codoni","year":"2022","journal-title":"JHEP Rep."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1002\/hep.32249","article-title":"Lettter to the editor on \u201cAutoimmune hepatitis after COVID-19 vaccination\u201d","volume":"75","author":"Mungmunpuntipantip","year":"2021","journal-title":"Hepatology"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.jhep.2023.04.033","article-title":"Nomenclature, Diagnosis and Management of Drug-induced Autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report","volume":"79","author":"Andrade","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_64","first-page":"86","article-title":"Infliximab-induced liver injury: Clinical phenotypes, autoimmunity and the role of corticosteroid treatment","volume":"76","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1002\/hep.23588","article-title":"Drug-induced autoimmune hepatitis: Clinical characteristics and prognosis","volume":"51","author":"Talwalkar","year":"2010","journal-title":"Hepatology"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1002\/hep.24481","article-title":"The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury","volume":"54","author":"Suzuki","year":"2011","journal-title":"Hepatology"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.jhep.2022.02.014","article-title":"Unexplained liver test elevations after SARS-CoV-2 vaccination","volume":"77","author":"Guardiola","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.14309\/ajg.0000000000001015","article-title":"Database Studies on Drug-Induced Liver Injury: The Importance of Causality Assessment","volume":"116","year":"2021","journal-title":"Am. J. Gastroenterol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e11621","DOI":"10.1097\/MD.0000000000011621","article-title":"Autoimmune hepatitis following influenza virus vaccination: Two case reports","volume":"97","author":"Sasaki","year":"2018","journal-title":"Medicine"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1080\/00365521.2016.1224379","article-title":"Vaccine-related autoimmune hepatitis: The same disease as idiopathic autoimmune hepatitis? Two clinical reports and review","volume":"52","author":"Doukas","year":"2017","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"261","DOI":"10.3945\/jn.110.133025","article-title":"Dietary supplement use in the United States, 2003\u20132006","volume":"141","author":"Bailey","year":"2011","journal-title":"J. Nutr."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.gastro.2005.05.006","article-title":"Spanish Group for the Study of Drug-Induced liver Disease. Drug-induced liver injury: An analysis of 461 incidences submitted to the Spanish Registry over a 10-year period","volume":"129","author":"Andrade","year":"2005","journal-title":"Gastroenterology"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/apt.13023","article-title":"Distinct phenotype of hepatotoxicity associated with illicit use of anabolic androgenic steroids","volume":"41","author":"Stephens","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1002\/hep.27317","article-title":"Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network","volume":"60","author":"Navarro","year":"2014","journal-title":"Hepatology"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1002\/hep.28813","article-title":"Liver Injury from Herbal and Dietary Supplements","volume":"65","author":"Navarro","year":"2017","journal-title":"Hepatology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1053\/j.gastro.2015.03.006","article-title":"Features and out- comes of 899 patients with drug-induced liver injury: The DILIN prospective study","volume":"148","author":"Chalasani","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jhep.2021.01.029","article-title":"Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry","volume":"75","author":"Stephens","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.jceh.2020.11.002","article-title":"The Indian network of drug- induced liver injury: Etiology, clinical features, outcome and prog- nostic markers in 1288 patients","volume":"11","author":"Devarbhavi","year":"2021","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"68","DOI":"10.7326\/0003-4819-144-1-200601030-00020","article-title":"Hepatotoxicity associated with supplements containing Chinese green tea (Camella sinensis)","volume":"144","author":"Bonkovsky","year":"2006","journal-title":"Ann. Intern. Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1016\/j.jhep.2005.11.041","article-title":"Acute hepatitis associated with the use of green tea infusions","volume":"44","year":"2006","journal-title":"J. Hepatol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.jhep.2007.05.010","article-title":"Serious adverse liver reactions associated with herbal weight loss supplements","volume":"47","author":"Olsson","year":"2007","journal-title":"J. Hepatol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"6999","DOI":"10.3748\/wjg.14.6999","article-title":"Hydroxycut hepatotoxicity: A case series and review of liver toxicity from herbal weight loss supplements","volume":"14","author":"Dara","year":"2008","journal-title":"World J. Gastroenterol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2682","DOI":"10.1007\/s10620-013-2687-9","article-title":"Catechins in dietary supplements and hepatotoxicity","volume":"58","author":"Navarro","year":"2013","journal-title":"Dig. Dis. Sci."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1007\/s00204-015-1521-x","article-title":"Hepatotoxicity of green tea: An update","volume":"89","author":"Mazzanti","year":"2015","journal-title":"Arch. Toxicol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1002\/hep.31538","article-title":"HLA-B*35:01 and Green Tea-Induced Liver Injury. 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