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Case Report
Not your usual drug-induced liver injury: Dolutegravir-associated granulomatous hepatitis
Southern African Journal of HIV Medicine | Vol 27, No 1 | a1817 |
DOI: https://doi.org/10.4102/sajhivmed.v27i1.1817
| © 2026 Muhammed Vally, Muhammad Ayob, Adam Mahomed, Kairoonisha Mahomed, Washington Mudini, Vikash Lala
| This work is licensed under CC Attribution 4.0
Submitted: 18 March 2026 | Published: 30 June 2026
Submitted: 18 March 2026 | Published: 30 June 2026
About the author(s)
Muhammed Vally, Division of Medical Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Division of Medical Gastroenterology, Department of Internal Medicine, Wits University Donald Gordon Medical Centre, Johannesburg, South AfricaMuhammad Ayob, Division of Medical Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Division of Medical Gastroenterology, Department of Internal Medicine, Wits University Donald Gordon Medical Centre, Johannesburg, South Africa
Adam Mahomed, Division of Medical Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Division of Medical Gastroenterology, Department of Internal Medicine, Wits University Donald Gordon Medical Centre, Johannesburg, South Africa
Kairoonisha Mahomed, Private Practice, Johannesburg, South Africa
Washington Mudini, Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Anatomical Pathology, Wits University Donald Gordon Medical Centre, Johannesburg, South Africa
Vikash Lala, Division of Medical Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Division of Medical Gastroenterology, Department of Internal Medicine, Wits University Donald Gordon Medical Centre, Johannesburg, South Africa
Abstract
Dolutegravir is an integrase inhibitor in first-line antiretroviral therapy in South Africa. We describe a patient who developed severe drug-induced liver injury on dolutegravir-containing antiretroviral treatment, in whom liver biopsy demonstrated subacute hepatic necrosis, non-necrotising granulomatous inflammation, and bile duct injury: an uncommon histological pattern in dolutegravir-associated hepatotoxicity.
Keywords
dolutegravir; drug-induced liver injury; granulomatous hepatitis; hepatotoxicity; liver biopsy; antiretroviral therapy; cholangitis; HIV.
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