A Case Report of Supplement-Induced Hepatitis in an Active Duty Service Member

Brazeau, Michael; Castaneda, Joni L.; Huitron, Sonny S.; Wang, James

doi:10.7205/milmed-d-14-00654

Cited by 11 publications

(15 citation statements)

References 6 publications

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“…'Standard medical therapy' or no therapeutic details were given for 24 patients. [9][10][11][12][13][14][15][16][17][18] Seventeen patients received antipruritic therapy, predominantly antihistamines and rifampicin, colestyramine, naltrexone and phenobarbital. Twelve patients received UDCA alone, 3 received corticosteroids alone (Abeles RDA) 19 20 and 12 received corticosteroids and UDCA (3 due to 'failure' of UDCA (Abeles RDA)), 19 21 6 patients received MARS 9 16 22 and 1 received plasmapheresis.…”

Section: Resultsmentioning

confidence: 99%

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Abeles

Foxton²,

Khan

et al. 2020

BMJ Open Gastroenterol

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BackgroundAnabolic androgenic steroids (AAS) usage is widespread and increasing. AAS drug-induced liver injury (DILI) is recognised but its clinical course and management is poorly described. We report 2 cases of AAS DILI with associated renal dysfunction, managed successfully with oral corticosteroids.MethodsA comprehensive review identified 50 further cases to characterise the clinical and biochemical course. Causality grading was calculated using the updated Roussel Uclaf Causality Assessment Method (RUCAM) score. Data are presented as median values.ResultsThe most common AAS taken was methyldrostanolone. Patients commonly present with jaundice and pruritus but may exhibit other constitutional symptoms. Patients presented 56 days after starting, and bilirubin peaked 28 days after stopping, AAS. Causality assessment was ‘unlikely’ in 1 (2%), ‘possible’ in 31 (60%) and ‘probable’ in 20 (38%). Peak values were: bilirubin 705 μmol/L, alanine transaminase 125 U/L, aspartate transaminase 71 U/L, alkaline phosphatase 262 U/L, gamma-glutamyl transferase 52 U/L, international normalised ratio 1.1. Liver biopsies showed ‘bland’ canalicular cholestasis. 43% of patients developed kidney injury (peak creatinine 225 μmol/L). Therapies included antipruritics, ursodeoxycholic acid and corticosteroids. No patients died or required liver transplantation.ConclusionsPhysicians are likely to encounter AAS DILI. Causality assessment using the updated RUCAM should be performed but defining indications and proving efficacy for therapies remains challenging.

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Section: Resultsmentioning

confidence: 99%

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Abeles

Foxton²,

Khan

et al. 2020

BMJ Open Gastroenterol

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“…On the other hand, while bodybuilding HDS were associated with a high rate of hospitalizations (71%), none of these patients died or required liver transplantation. Bodybuilding agents sometimes contain anabolic steroids, which have been associated with several patterns of injury, most commonly with acute cholestasis or cholestatic hepatitis (26) along with sinusoidal dilation (27) and peliosis hepatis (28) (Figure 2B). They have also been associated with hepatocellular tumors, particularly hepatocellular adenomas (29).…”

Section: Recent Reports Of Histological Injury Patterns In Dilimentioning

confidence: 99%

Recent Advances in the Histopathology of Drug-Induced Liver Injury

Kleiner

2018

Surgical Pathology Clinics

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Drug-induced liver injury (DILI) is constantly changing as new drugs are approved and as new herbals and dietary supplements (HDS) reach the market. The pathologist plays a key role in the evaluation of DILI by classifying and interpreting the histologic findings considering patients' medical history and drug exposure. The liver biopsy findings may suggest alternative explanations of the injury and additional testing that should be performed to exclude non-DILI causes. Recent reports of iatrogenic liver injury are reviewed with attention to immunomodulatory and antineoplastic agents as well as reports of injury associated with HDS use.

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“…Several patterns of injury such as focal nodular hyperplasia, hepatocellular adenoma [ 27 ], hepatocellular carcinoma [ 28 ], peliosis hepatis [ 29 , 30 ], spontaneous hepatic rupture [ 31 ] and, specially, cholestasis hepatitis [ 11 , 24 , 25 , 26 , 32 , 33 , 34 , 35 , 36 ], have been described. However, in a recent study, AAS hepatotoxicity was associated with a distinct phenotype, characterized by considerable total bilirubin (TB) elevations independent of type of damage, in addition to low values of transaminases and alkaline phosphatase, compared to values in liver injury due to convencional drugs and herbs [ 10 , 11 , 24 , 25 , 26 , 37 ].…”

Section: Reported Cases Of Dietary Supplements-induced Liver Injurmentioning

confidence: 99%

Hepatotoxicity by Dietary Supplements: A Tabular Listing and Clinical Characteristics

García‐Cortés

Robles‐Díaz

Ortega‐Alonso

et al. 2016

IJMS

128

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Dietary supplements (DS) are extensively consumed worldwide despite unproven efficacy. The true incidence of DS-induced liver injury (DSILI) is unknown but is probably under-diagnosed due to the general belief of safety of these products. Reported cases of herbals and DS-induced liver injury are increasing worldwide. The aim of this manuscript is to report a tabular listing with a description of DS associated with hepatotoxicity as well as review the phenotype and severity of DSILI. Natural remedies related to hepatotoxicity can be divided into herbal product-induced liver injury and DS-induced liver injury. In this article, we describe different DS associated with liver injury, some of them manufactured DS containing several ingredients (Herbalife™ products, Hydroxycut™, LipoKinetix™, UCP-1 and OxyELITE™) while others have a single ingredient (green tea extract, linoleic acid, usnic acid, 1,3-Dimethylamylamine, vitamin A, Garcinia cambogia and ma huang). Additional DS containing some of the aforementioned ingredients implicated in liver injury are also covered. We have also included illicit androgenic anabolic steroids for bodybuilding in this work, as they are frequently sold under the denomination of DS despite being conventional drugs.

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A Case Report of Supplement-Induced Hepatitis in an Active Duty Service Member

Cited by 11 publications

References 6 publications

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Recent Advances in the Histopathology of Drug-Induced Liver Injury

Hepatotoxicity by Dietary Supplements: A Tabular Listing and Clinical Characteristics

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