Drug-induced liver injury (DILI) in children remains a diagnostic challenge due to its broad clinical and histologic spectrum. Based on pathogenesis, DILI is classified as idiosyncratic, intrinsic (direct), or indirect. In the United States, antimicrobials and antiepileptic medications are the most commonly implicated agents. Because histologic features are often nonspecific, diagnosis and assessment of causality rely on clinicopathologic correlation. Although not always required, liver biopsy can aid in characterizing injury patterns, assessing severity, and excluding mimickers. This review highlights the major morphologic patterns of pediatric DILI, associated agents, and practical considerations for biopsy interpretation in routine practice.
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