University of Florida College of Medicine Jacksonville, FL
Landen Shane Burstiner, DO, MSc1, Nathan Heathcoat, MD1, Perla Jimenez, MD1, Sneh Parekh, DO1, Yasasvhinie Santharam, DO1, Nadim Qadir, DO2, Anvit Reddy, DO2, Luke Stachler, MD1, Gerardo Diaz Garcia, DO2, Natalie Axelrod, BS1, Christopher Lamprecht, BS1, Jeff House, DO1 1University of Florida College of Medicine, Jacksonville, FL; 2University of Florida College of Medicine - 655 W 8th St Jacksonville, FL 32221UNITED STATES - Jacksonville, FL, Jacksonville, FL Introduction: Phosphatidylcholine (PC) is a polyunsaturated fatty acid compound that comprises 40-60% of human cellular membranes. Intravenous supplementation of PC has no FDA-approved indications and is not covered by insurance, but is touted as a treatment for many diseases including hyperlipidemia, atherosclerosis, dementia, and MASLD. The most popular brand of PC formulation costs at least $250 per infusion.
Case Description/
Methods: We present a 69-year-old female with a past medical history of diabetes mellitus, myocardial infarcts, and hyperlipidemia who was brought from a medical spa to the ER for sharp, 10/10, right-sided pain immediately following her 10th infusion of PC. Abdominal exam revealed mild tenderness to palpation in all four quadrants. Denied recent travel, drugs, nicotine, alcohol use, and any other new medications, vitamins, or supplements.
CT angiography and right upper quadrant ultrasound with doppler were completed. They were remarkable for a 17 cm liver with increased echogenicity suggestive of steatosis, but negative for gallstones, duct dilation, or advanced atherosclerotic disease in the abdominal vessels. Labs revealed AST 1868, ALT 1255, ALP 140, with lipase, lactic acid, total bilirubin, and acetaminophen level within normal limits. Hepatitis panel, ANA, antimitochondrial, ANCA, antismooth muscle, liver kidney microsomal antibodies, and HIV were negative.
After an overnight stay the patient’s abdominal pain resolved, transaminases began to downtrend, and she was discharged. She was counseled to discontinue PC infusions, repeat labs in a week, and follow up with her primary care provider. Discussion: Patient did not resume PC infusions and liver function tests demonstrated improvement 8 days (AST 21, ALT 134) and 23 days after presentation (AST 14, ALT 21). Total cholesterol (242 - > 190), LDL (166 - > 113), and HDL decreased (54 - > 51) over a four month period, two of which she was receiving PC along with continuing niacin.
While it cannot be proven with certainty that the newly started PC infusions caused our patient’s presentation, all other common etiologies were ruled out, including ischemic, infectious, biliary, autoimmune, and use of other drugs. This is the first known report of severe transaminitis secondary to PC infusions. Patients should be cautious about using non-FDA approved treatments and physicians should continue to diligently ask patients about use of non-prescribed vitamins, supplements, or treatments.
Disclosures: Landen Shane Burstiner indicated no relevant financial relationships. Nathan Heathcoat indicated no relevant financial relationships. Perla Jimenez indicated no relevant financial relationships. Sneh Parekh indicated no relevant financial relationships. Yasasvhinie Santharam indicated no relevant financial relationships. Nadim Qadir indicated no relevant financial relationships. Anvit Reddy indicated no relevant financial relationships. Luke Stachler indicated no relevant financial relationships. Gerardo Diaz Garcia indicated no relevant financial relationships. Natalie Axelrod indicated no relevant financial relationships. Christopher Lamprecht indicated no relevant financial relationships. Jeff House indicated no relevant financial relationships.
Landen Shane Burstiner, DO, MSc1, Nathan Heathcoat, MD1, Perla Jimenez, MD1, Sneh Parekh, DO1, Yasasvhinie Santharam, DO1, Nadim Qadir, DO2, Anvit Reddy, DO2, Luke Stachler, MD1, Gerardo Diaz Garcia, DO2, Natalie Axelrod, BS1, Christopher Lamprecht, BS1, Jeff House, DO1. P6134 - Phosphatidylcholine-Induced Transaminitis - How One Patient’s Longing to Lower Lipids Left Her Liver Languishing, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
