A0576 - Toxic Hepatitis During Self-Medication With Conjugated Linoleic Acid

Rahul R. Thakkar, MD¹, Keerthana Pakanati, MD¹, Bryce Bushe, MD², Erik Rahimi, MD^3
1Baylor Scott & White Round Rock, Round Rock, TX; ²Baylor Scott & White Round Rock/Lakeway, Round Rock, TX; ³Baylor Scott and White Round Rock/Lakeway, Round Rock, TX

Introduction: Despite the growing prevalence of herbal and dietary supplements in patient care, there is limited knowledge regarding their safety and efficacy due to the great variability in their use and subsequent lack of randomized controlled trials; furthermore, there is a general reluctance in discussing their use in the clinical setting, increasing the risk of adverse effects.¹ Conjugated linoleic acid (CLA) is a polyunsaturated omega-6 fatty acid found in ruminant milk fat and meat. A synthetic form of CLA, produced from certain vegetable oils, is found in dietary supplements that are often used for weight loss.² CLA-induced hepatotoxicity is a rare but adverse effect that warrants greater awareness, particularly given the widespread availability and popularity of CLA supplements. In current literature, this is only the fourth known case of CLA-induced hepatotoxicity, the second in the United States.^3-5

Case Description/Methods: A 77-year-old female with a history of calculous cholecystitis s/p cholecystectomy presented to ED with a one-day history of epigastric pain with associated nausea and dry-heaving. She frustratedly noted similar episodes over the past few months despite her healthy lifestyle. In the ED, her vital signs were stable and her physical exam was benign. Serum lipase was normal but LFTs were elevated with total bilirubin 1.5, ALP 398, AST 1003, AST 409. CT imaging did not demonstrate biliary dilatation or filling defects. Gastroenterology was consulted for further evaluation of her elevated transaminases, the pattern of which was suggestive of viral hepatitis, drug-induced liver injury (DILI), or ischemic hepatitis. Investigation into these etiologies – including a viral hepatitis panel, serum acetaminophen level, anti-nuclear antibody titer, and a careful medication reconciliation – did not reveal any inciting factors. Fortunately, solely with supportive care, her symptoms gradually improved along with her LFTs. On further interview, the patient revealed that she had recently started consuming CLA-safflower oil to lose weight. She was instructed to stop its use and follow up closely with her PCP, during which her LFTs normalized.

Discussion: Synthetic conjugated linoleic acid – commonly used in dietary supplements advertised for weight loss – may rarely lead to toxic hepatitis. With a significantly increasing proportion of DILI secondary to herbal and dietary supplements, inquiring about their use may be imperative in stopping offending agents and preventing long-term liver injury.


Disclosures:


Rahul R. Thakkar, MD¹, Keerthana Pakanati, MD¹, Bryce Bushe, MD², Erik Rahimi, MD³. A0576 - Toxic Hepatitis During Self-Medication With Conjugated Linoleic Acid, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.