When do you pursue liver biopsy for assessment of DILI?

In the setting of an acute elevation of liver chemistry tests, DILI should always be considered in the differential diagnosis. If the serological workup for abnormal liver tests is unrevealing as well as abdominal imaging, expectant management should ensue with the discontinuation of any potential offending agent. Biopsy should be pursued if the liver abnormalities persist, in an effort to establish a formal diagnosis of DILI. This becomes important if drug-induced AIH is found or if the potential need for corticosteroid treatment becomes necessary. Biopsy also may be prognostic for recovery in severe cases of DILI, especially when the DILI occurs in the background of a chronic concurrent liver disease, such as MASLD. It should be noted tha...