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Case Report
 
A unique case of autoimmune hepatitis: Can dietary weight-loss supplements act as toxin-induced precipitants?
Madeline Sterling1, Sarang Kim2
1Department of Internal Medicine, New York Presbyterian - Weill Cornell Medical College 525 East 68th Street New York NY 10021.
2Department of General Internal Medicine, Rutgers University – Robert Wood Johnson University Hospital, Clinical Academic Building, 125 Paterson Street, Suite 5100A New Brunswick, NJ 08901-1962.

Article ID: 100004Z09MS2015
doi:10.5348/Z09-2015-4-CR-4

Address correspondence to:
Madeline Sterling
MD, MPH, Department of Internal Medicine
New York Presbyterian - Weill Cornell Medical College 525
East 68th Street New York NY 10021
India

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How to cite this article:
Sterling M, Kim S. A unique case of autoimmune hepatitis: Can dietary weight-loss supplements act as toxin-induced precipitants? J Case Rep Images Med 2015;1:14–17.


Abstract
Introduction: Dietary and weight loss supplements have been shown to cause acute hepatitis through toxic liver injury. Herein, we present a case of a woman who was found to have both acute hepatitis and autoimmune hepatitis (AIH) in the setting of ingesting a popular weight loss supplement, Hydroxycut®.
Case Report: A 29-year-old female without significant past medical history presented to our hospital with three weeks of abdominal pain, decreased appetite and jaundice. She intentionally lost 15 pounds in the last four months using two weight loss supplements, Hydroxycut and Herbalife. Initial lab work at her primary care physician's office revealed AST of 2409 U/L, ALT of 2000 U/L, TBili of 15.1 md/dL. She was advised to go to the emergency room given her physician's concern for liver injury. In the hospital, her vital signs were within normal limits (WNL) and her physical exam revealed jaundice, scleral icterus and mild epigastric tenderness, without encephalopathy. After other etiologies of acute hepatitis were ruled out, autoimmune panels were ordered which revealed an elevated ANA at 1:1280, A-SMA 1:10, normal AMA and LKM1 titers. An US-guided liver biopsy showed findings consistent with both acute hepatocyte necrosis secondary to toxin exposure and ongoing autoimmune hepatitis (AIH). She was started on prednisone and AZT for AIH and her transaminases, hyperbilirubinemia and jaundice improved. She was counseled on the dangers of herbal supplements.
Conclusion: This case offers new insight into the conceptualization of AIH and the ability of weight-loss supplements to act as precipitants of both acute and chronic hepatitis. In the context of the obesity epidemic, more attention should be given to these dietary aids and their adverse effects.

Keywords: Autoimmune hepatitis, Herbal supplements, Hydroxycut, Liver injury, Public health, Toxicology, Weight loss supplements, Women's health


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Author Contributions
Madeline Sterling – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sarang Kim – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Madeline Sterling et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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