Division
East Florida
Hospital
HCA Florida Aventura Hospital
Specialty
Internal Medicine
Document Type
Poster
Publication Date
2025
Keywords
nutritional supplements, drug-induced liver injury, herbal induced liver injury
Disciplines
Digestive System Diseases | Gastroenterology | Internal Medicine
Abstract
Introduction Drug induced liver injury (DILI) contributes to a significant portion of acute liver injuries and acute liver failure in the west. DILI accounts for approximately 11% of acute liver failure cases in the US according to ACG. Insulting agents are numerous and well documented in the NIH LiverTox database, however the rarity and complexity of individual agents is a matter of ongoing study. Case Description/Methods A 52 year old man with PMH of HTN and HLD presents for a 2 week history of abdominal swelling, bilateral lower extremity swelling, decreased appetite, and positional shortness of breath. He endorses occasionally drinking an oz. of vodka before bed to fall asleep but denied heavy binge drinking. His medications were amlodipine, HCTZ, and atorvastatin. Of note this patient was very health conscious and took a regimen of natural remedies including turmeric pills, red yeast paste, Zinc, and fish oil. Labs were significant for ALT = 815 u/L, AST = 2480 u/L, Alk Phos = 238 u/L, T. Bilirubin = 3.2 mg/dL and creatinine phosphokinase (CPK) = 18,000 u/L. An infectious workup was negative for viral hepatitis, syphilis, and Leptospira. Immunological workup was negative for ANA, Anti-smooth muscle ab, and Anti-LKM ab. An abdominal US revealed trace subhepatic ascites. Portal vein US showed patent hepatopetal flow. CT scan showed a normal size and contour of the liver. An echocardiogram showed normal left ventricle with 55% ejection fraction. After home medications were discontinued, the liver function tests and CPK trended down. Spironolactone helped reduce swelling. Discussion This is a case of new onset hepatocellular pattern (R factor 7.4) acute liver injury without past chronic hepatic disease. DILI second to atorvastatin, turmeric, and Red Yeast use was the presumed diagnosis as these agents have likelihood scores of A, B, and C respectively. Although statins are a class A cause of liver injury, the incidence of a >3x elevation of ULN is exceedingly rare (< 1% of cases) In the case of turmeric induced DILI, most cases present with mild elevations of Alk. Phos. and marked elevation of AST and ALT ( > 1000). Interestingly most reports of turmeric induced DILI had a combination of multiple offending agents such as this case. Red yeast is a traditional Chinese herbal remedy containing monacolin K, an identical agent to lovastatin. Prospective controlled studies do not show a significant enzyme increase in LFTs, but there are isolated case reports with liver injury second to consumption of red yeast.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Nahas, John V.; Ceballos, Sinay; and Kasmin, Franklin, "Turmeric, Red Yeast Paste, and Statins: A recipe for DILI" (2025). East Florida Division GME Research Day 2025. 44.
https://scholarlycommons.hcahealthcare.com/eastflorida2025/44