Hepatotoxicity Associated With the Use of OxyELITE Pro: A Nutritional Supplement

Abstract

Introduction: Complimentary and alternative medical (CAM) therapies are commonly used in the United States. Several of these agents have been associated with hepatotoxicity. We present a case of severe cholestatic hepatitis attributed to the use of OxyELITE Pro, a new herbal weight loss remedy. Case Report: A previously healthy 33-year-old Laotian woman presented with acute onset of jaundice, nausea, and vomiting. She had been taking OxyELITE Pro for weight loss for approximately 3 months. On exam, she was jaundiced, but had no stigmata of chronic liver disease and no asterixis. Lab studies revealed a normal CBC, INR 1.7, alkaline phosphatase 194, AST 1008, ALT 1042, total bilirubin 12.2. Serologies were negative for evidence of acute viral hepatitis, autoimmune hepatitis, or metabolic causes of liver disease. Imaging studies were unremarkable. A transjugular biopsy revealed approximately 10% hepatocellular necrosis, and was read as most consistent with drug-induced hepatitis. Despite discontinuation of the supplement, her liver function tests worsened. She was started on prednisone and eventually had dramatic improvement in her LFTs. Conclusions: OxyELITE Pro is another herbal supplement that appears to have associated hepatotoxicity. At the same time that we saw this case, others were noted across the country. The majority were self-limited, but approximately 10% died or needed liver transplant. This entity should be suspected if both chronological and clinical criteria are met. Liver biopsy may be helpful to support the diagnosis, rule out other causes of hepatitis, and assist in prognostication. The mainstay of treatment is discontinuation of the supplement and supportive care. If liver function continues to worsen despite these actions, corticosteroids might be necessary. Clinicians should remember to question patients with unexplained hepatitis or jaundice about the use of medications as well as dietary and herbal supplements.