title: Dietary supplement implicated in fulminant hepatic failure in a well-controlled Wilson disease patient.
abstract: We encountered a patient with previously well-controlled Wilson disease who experienced fulminant hepatic failure with hemolytic anemia, possibly caused by the dietary supplement Health Proportion(®) (Jubilant Co., Ltd., Ehime, Japan). A 21-year-old woman was admitted to our hospital with marked liver dysfunction and severe hemolytic anemia. Free serum copper level was elevated at 101 μg/dl, and urinary copper excretion was extremely increased (25,600 μg/day). Plasma exchange and continuous hemodiafiltration were performed to remove serum copper and to treat the hemolytic anemia. However, liver function did not improve, and she underwent liver transplantation on 28th day after admission. Copper and iron contents in the resected liver were high at 851.9 μg and 551.7 μg/dry liver weight (g), respectively, despite the patient having regularly taken D-penicillamine since diagnosis and having a well-controlled copper level 1 year before her admission. Two months before admission, the patient had taken a dietary supplement made from soybeans for 1 month. This supplement was labeled as containing large amounts of copper and iron, and we assume that this caused fulminant hepatic failure with hemolytic crisis in this patient. It is important to be mindful of the micronutrient content of dietary supplements, especially for metabolic disorder patients.
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Atarashi
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan. terutaka-tym@umin.ac.jp.
authors.forename: Terumi
authors.initials: T
authors.lastname: Takahara
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kudo
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tajiri
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tokimitsu
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakayama
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
authors.forename: Katsuharu
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yata
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Minemura
authors.affiliation: Division of Transfusion Medicine and Cell Therapy, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasumura
authors.affiliation: Second Department of Surgery, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Onishi
authors.affiliation: Second Department of Surgery, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tsukada
authors.affiliation: Department of Diagnostic Pathology, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tsuneyama
authors.affiliation: Department of Diagnostic Pathology, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Takano
authors.affiliation: Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Sugiyama
keywords: Copper; Dietary supplements; Fulminant hepatic failure; Wilson disease