S2569 Drug Induced Liver Injury by Synthetic Cannabinoid Ingestion

Abstract

INTRODUCTION: Drug-induced liver injury (DILI) is a well-known consequence of many ingested substances. It can be found in a range of presentations from asymptomatic to an acute liver injury. Symptomatic patients can be identified and appropriately counseled, but the asymptomatic consumption can produce in the long run a chronic liver injury. It is imperative to find all drugs that can cause DILI and report them to stop the progression of this injury and to advise against its use. Here we present a case of a DILI after ingestion of Synthetic Cannabinoid, a legal psychoactive designer drug known as Spice/K2. CASE DESCRIPTION/METHODS: A 30-year-old man with medical history of IVDA and Chronic Hepatitis C was brought to the emergency department after 24 hours of oral ingestion of an uncertain amount of Spice/K2. Patient started experiencing symptoms such as nausea, abdominal pain and non-bilious, non bloody emesis. Denied changes in stool or urine, diplopia, hallucinations or neurologic symptoms. Vital signs were unremarkable. Physical examination remarkable for non-icteric appearance with adequate bowel sounds, diffuse abdominal discomfort to palpation, dullness to percussion along with negative peritoneal signs. Laboratories remarkable for AST 200 U/L, ALT 324 U/L, ALP 180 U/L, and Total Bilirubin 1.66 mg/dL. The Coagulation panel showed INR 1.02, PT 11.2 and PTT 26.9. Toxicology positive for cocaine and opioid and negative for EOTH, THC, and acetaminophen. Abdominopelvic CT with IV contrast ruled out a surgical emergency. Patient was admitted to follow up DILI evolution and halt progression to more severe disease with conservatory treatment. Serial laboratory tests showed an improvement of the liver injury, which correlated with resolution of symptoms and PO tolerance. Three days after admission the patient was discharged. DISCUSSION: This vignette illustrates a unique presentation of a DILI caused by the consumption of Spice/K2. DILI was characterized as a mixed hepatocellular and cholestatic injury in our patient. To our knowledge, this is the first reported case that showed liver injury after the ingestion of these substances. Spice/K2 are not detectable by routine toxicology and unfortunately, a test for this drug was not available in our institution. In order to start identifying this compound and with certainty confirm that this drug is causing liver damage we want to report this case to inform the medical community about its possible effect, management, and outcome of the ingestion of Spice/K2.