ACCEPTED: CLINICAL VIGNETTES/CASE REPORTS—LIVER
An Uncommon Culprit of Acute Hepatitis
Castineira, Janyll I. DO1; Park, Angela S. DO1; Muso, Ergen DO1; Kudelko, Marc A. DO2
1. Largo Medical Center, Largo, FL;
2. Largo Medical Center, Pinellas Park, FL
Energy drinks contain an array of compounds that claim to provide a burst of energy, making them increasingly popular in recent years. Little is known about the effects of frequent or high dose ingestion of these products. Additionally, in the presence of concomitant risk factors, a synergistic effect may contribute to the development of acute liver injury, which can potentially progress to fulminant liver failure. We report a case of a previously healthy 43-year-old woman who presented with complaints of abdominal pain, jaundice, anorexia and weight loss. Blood tests were significant for AST 299 U/L, ALT 543 U/L, ALP 489 U/L and total bilirubin 11.5 μmol/L. The patient initially denied recent dietary changes and the use of illicit drugs, prescription medications or over-the-counter supplements. CT Abdomen/Pelvis was remarkable for hepatosteatosis. She was admitted to the hospital for further evaluation. The patient had no history of liver disease and reported moderate alcohol intake but had refrained from all alcohol use for two weeks prior to presentation. BAL was negative. No further stigmata of underlying liver disease were present on exam. Upon further questioning, the patient divulged that she was ingesting 2-3 energy shot drinks per day over a period of 3 months in order to cope with work-related stress. She noted jaundice several days prior to hospitalization, prompting her to cease consumption. A comprehensive work-up excluded alternative etiologies of hepatitis. We suspect the development of acute hepatitis in this patient was likely related to the excessive consumption of energy drinks. Supportive care was continued, liver enzymes down trended, jaundice improved and the patient was discharged home. She was advised to limit alcohol intake and avoid consumption of energy drinks. She was instructed to follow-up outpatient for continued monitoring of liver enzymes. According to our review of the literature, this is the fourth documented case of suspected energy drink-induced acute hepatitis. In reporting this case we encourage clinicians to identify causative agents in the presence of unexplained liver injury in order to promote early removal of the offending agent and prevent progression to more serious complications. We also encourage clinicians to thoroughly screen patients for risk factors for the development of liver injury. High-risk individuals should be educated on the avoidance of less commonly thought of hepatotoxic agents.© The American College of Gastroenterology 2018. All Rights Reserved.