title: A case of supplement-induced hepatotoxicity.
abstract: A 45-year-old Caucasian male presented with a two-week history of jaundice and right-upper quadrant (RUQ) abdominal pain. Transaminases and biliary enzymes were markedly elevated with hyperferritinemia and mildly elevated INR. Imaging tests showed no significant abnormality. He denied prescription or over-the-counter (OTC) medication use, but he had been taking at least 9 dietary supplements for 12 months. Other causes of liver disease were excluded. His supplements were discontinued, and his liver-associated enzymes significantly markedly improved over the next 6 weeks and remained normal after one year suggesting supplement-induced hepatotoxicity. Due to the number of supplements, no specific agent could be identified as the primary cause of his liver injury. This case illustrates the importance of inquiring and educating patients of the potential harmful risks of over-the-counter medications and supplements.
authors.affiliation: Department of Medicine, Madigan Army Medical Center, Tacoma, WA 98431, USA.
authors.forename: Fong-Kuei Frank
authors.initials: FK
authors.lastname: Cheng
authors.forename: Peter
authors.initials: P
authors.lastname: Dunaway
references.citation: FASEB J. 1996 Jul;10(9):1102-7
references.pmid: 8801174
references.citation: JAMA. 1998 Nov 11;280(18):1569-75
references.pmid: 9820257
references.citation: Clin Toxicol (Phila). 2006;44(6-7):803-932
references.pmid: 17015284
references.citation: Hepatology. 2005 May;41(5):1179-97
references.pmid: 15841455
references.citation: N Engl J Med. 2003 Jul 31;349(5):474-85
references.pmid: 12890847
references.citation: Clin Liver Dis. 2009 May;13(2):277-94
references.pmid: 19442919
references.citation: Gastroenterol Clin North Am. 1995 Dec;24(4):937-67
references.pmid: 8749906
references.citation: J Hepatol. 1997;26 Suppl 1:47-51
references.pmid: 9138129