The diagnosis and management of Drug-induced Liver Injury (DILI) remains a challenge in many situations, especially when dealing with idiosyncratic type of DILI. There are currently the RUCAM (Roussel Uclaf Causality Assessment Method) and the DILIN - proposed structured expert opinion assessment method that helps support the diagnosis of DILI, but without specific diagnostic marker, it remains difficult for clinicians to be absolutely confident of the diagnosis of DILI. It is always prudent to withdraw drug in use when in doubt. Drug re-challenge may be considered, but must be done with caution and vigilance, if the previous episode was not severe or life-threatening.

As the onset of chronic DILI is more insidious, having a high index of suspicion is necessary when we encounter deranged liver function test results. Some patients can progress to cirrhosis and hepatic decompensation.

Steroid treatment can be helpful in patients who have the autoimmune or immuno-allergic type of DILI. Liver transplantation may be the only option for those who progress to development of liver failure.

With new therapeutic options for various diseases. we should always be on a look out for new therapeutic agents which may be the etiology for DILI. One such examples will be immune checkpoint inhibitors. In addition, populations that are more vulnerable to DILI, such as the elderly and the obese, are increasing in many parts of the world. We therefore need to be mindful of these predisposing factors in association with drug use that may not otherwise give rise to DILI.