2429 Acute Severe Cholestatic Hepatitis Secondary to Emerge Weight Loss Supplement

Abstract

INTRODUCTION: Herbal and dietary supplements (HDS) are an important cause of liver injury. EmergeR weight loss supplement is advertised as a product which burns fat and stimulates weight loss. We report a case of acute severe cholestatic hepatitis after consumption of EmergeR in a 32 year-old man. This case highlights a previously unreported and important association between this supplement and hepatotoxicity and the importance of obtaining a through medication history including HDS. CASE DESCRIPTION/METHODS: A 32-year-old male presented to hepatology clinic for evaluation of jaundice and elevated liver tests. He was well until 1 week ago when he developed flu-like symptoms, fatigue, jaundice, pruritus, dark urine and pale stools. He denied other symptoms, recent travel, reported rare alcohol use and did not take any other medications. However, he started a new weight loss supplement, EmergeR 3 weeks ago and had normal liver tests prior (Table 1). Exam was remarkable for a BMI of 35 and scleral icterus. Liver tests were elevated with AST 987 IU/L, ALT 2305 IU/L, total bilirubin 7.2 mg/dl and INR 1.1 (Table 1). Testing for other viral causes was negative. Abdominal ultrasound showed hepatic steatosis. The patient was advised to stop EmergeR immediately and undergo liver tests and INR weekly. 4 weeks later (7 weeks after starting EmergeR), patient was asymptomatic with resolution of prior symptoms. DISCUSSION: Despite the widespread use and potential severe side effects associated with weight loss supplements, HDS do not require FDA approval prior to marketing.3 This emphasizes the need for physicians to report potential side effects associated with weight loss products as continued use without awareness or proper monitoring can lead to severe liver injury. To our knowledge, this is the first reported case of acute cholestatic hepatitis from EmergeR use. The temporal relationship of acute liver injury with the use of Emerge, improvement after withdrawal and absence of other possible causes strongly suggested that liver injury was secondary to this supplement. As EmergeR contains a variety of ingredients which may also be contaminated by an unknown toxic botanical or synthetic chemical, it remains unclear which component of EmergeR caused liver injury.4 As patients may exhibit subtle symptoms such as fatigue and nausea at the time of presentation, a high index of suspicion is required for diagnosis of HDS induced liver injury along with a through HDS use history.