University of Cincinnati Medical Center Cincinnati, OH
Farrah Rahim, MD1, Anthony Flowers, MD2, Amoah Yeboah-Korang, MD3 1University of Cincinnati Medical Center, Cincinnati, OH; 2TriHealth, Norwood, OH; 3University of Cincinnati, Cincinnati, OH Introduction: With rising obesity rates and limited access to prescription weight loss drugs, more people are turning to over-the-counter herbal and dietary supplements (HDS) for weight loss. HDS-induced liver injury (HILI) from weight loss products poses a diagnostic challenge. HILI can mimic other hepatobiliary disorders, and patients are less likely to report their HDS use to providers without detailed medication use questioning.
Case Description/
Methods: A 39-year-old male with history of MASH presented with epigastric pain, jaundice, and subjective fevers. Labs showed ALT 269, AST 216, ALP 383, bilirubin 8.5 (direct 5.5). He mentioned using an HDS to increase his metabolism, because insurance denied prescription weight loss medications. CT abdomen showed reactive lymphadenopathy in the upper abdomen. Antibiotics were started for suspected biliary infection. Serologies for toxic, viral, fungal, autoimmune and hereditary liver disease were negative. MRCP showed diffuse hepatic steatosis. With persistent epigastric pain and worsening cholestasis, choledocholithiasis was suspected. Subsequent ERCP was normal; biliary stent was placed. Liver tests did not improve, so liver biopsy was obtained, showing moderate steatohepatitis, significant bile ductular proliferation, scattered mild plasmocytic infiltrate, and microgranulomas. Autoimmune hepatitis with AMA-negative PBC was the leading diagnosis. Ursodiol and steroids were started. The patient was discharged home after 10 days with AST 65, ALT 98, ALP 487, bilirubin 2.8 (direct 1.3) and continued treatment. The patient followed up in clinic and revealed that he used three bottles of weight loss HDS for 3 months before liver injury onset. These products contained green tea leaf extract, turmeric root powder, turmeric root extract, black pepper fruit extract. With this new information, the liver injury was deemed likely due to HILI. Prednisone and ursodiol were discontinued. All liver tests normalized and remained normal 10 weeks after liver injury onset. Discussion: This case shows how HILI is a major diagnostic challenge and can mimic other hepatobiliary conditions. Our patient took products containing well-documented synergistic hepatotoxins (green tea leaf extract, and turmeric with black pepper) which increase turmeric bioavailability and potential toxicity. Clinicians should have a high index of suspicion for HILI in cases of unexplained liver injury. A detailed medication use history is needed for early diagnosis and to avoid unnecessary testing.
Disclosures: Farrah Rahim indicated no relevant financial relationships. Anthony Flowers indicated no relevant financial relationships. Amoah Yeboah-Korang indicated no relevant financial relationships.
Farrah Rahim, MD1, Anthony Flowers, MD2, Amoah Yeboah-Korang, MD3. P1840 - The Mystery Is in the History: HDS-Induced Liver Injury, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
