P1853 - Hydroxycut-Induced Autoimmune Liver Disease

Omar T. Ahmed, MBBCh¹, Sanket Patel, DO², Bashar Sharma, MD¹, Lisa Rossi, MD^3
1University of Connecticut Health Center, Farmington, CT; ²University of Connecticut Health Center, Hartford, CT; ³Saint Francis Hospital, Hartford, CT

Introduction: Hydroxycut is an herbal supplement marketed as a “fat burner” that was voluntarily recalled in 2009 after a warning was issued by the FDA for potential hepatotoxicity. The product reappeared on the market in 2010 and subsequently, case reports have emerged describing Hydroxycut induced hepatotoxicity. We present a patient with a rare presentation of Hydroxycut induced liver injury.

Case Description/Methods: A 64-year-old woman with a history of cholecystectomy and obesity presented with a 1-month history of worsening right upper quadrant abdominal pain, jaundice and nausea. Symptoms occurred approximately 1 month after starting Hydroxycut. Labs (summarized in Table 1) revealed elevated liver enzymes, positive ANA titer, elevated ASMA and IgG. Alcoholic liver disease, viral hepatitis, hemochromatosis, and Wilson disease were ruled out. Liver biopsy showed acute cholestatic injury and mixed inflammatory cells including plasma cells and eosinophils in the portal and lobular areas consistent with drug induced liver injury (DILI), but autoimmune hepatitis (AIH) could not be ruled out. During the hospitalization, she received NAC and prednisone, with subsequent improvement of her symptoms and liver tests. She was discharged on a prednisone taper. Outpatient labs 10 days later showed improvement of liver enzymes (Table 1).

Discussion: Our patient had recently started Hydroxycut, presented with acute liver injury consistent with DILI, had positive serological markers consistent with simplified AIH score of 7 points, and responded appropriately to the prednisone taper. These findings suggest drug-induced autoimmune liver disease (DIAILD), which have been previously reported with other drugs. DIAILD remains a poorly understood entity, and several theories have been suggested to explain its pathophysiology. First, drug-induced development of autoantibodies leading to AIH that continues to progress and require lifelong immunosuppressive therapy (IST). Second, drug- induced autoantibodies that are exclusively associated with the presence of the drug, and resolves spontaneously with drug withdrawal or with IST. Third, the DILI can trigger the reactivation of a quiescent AIH or unmask a new diagnosis of AIH. It is not yet clear how our patient will respond to withdrawal of IST or if she will develop chronic AIH requiring lifelong IST. This case demonstrates the potential of dietary supplements to result in DILI with long term negative outcomes including AIH and sustained liver damage.



Disclosures:


Omar T. Ahmed, MBBCh¹, Sanket Patel, DO², Bashar Sharma, MD¹, Lisa Rossi, MD³. P1853 - Hydroxycut-Induced Autoimmune Liver Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.