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Drug-induced liver injury leading to acute liver failure: case report A 36-year-old man developed drug-induced liver injury (DILI) leading to acute liver failure (ALF) during treatment with acetyltyrosine/caffeine/oxilofrine/salix-alba as a thermogenic dietary supplement. The man, who did not have any history of usage of alcohol, tobacco and illegal drugs, had a body mass index of 22.2. He started using oral acetyl-tyrosine/caffeine/oxilofrine/salix-alba [Thermo Gun] one capsule daily as a thermogenic dietary supplement [doses not stated]. The thermogenic dietary supplement contains N-acetyl-L-tyrosine, 1,3,7-trimenthylxanthine, white willow and 1-hydroxypholedrine. After 7 days of dietary supplement usage, he developed jaundice and malaise. Following consultation with a hepatologist, the man discontinued the use of acetyl-tyrosine/caffeine/oxilofrine/salix-alba. Laboratory tests showed hyperbilirubinaemia and elevated ALT and AST. He was diagnosed with DILI, and was hospitalised for inpatient care with close monitoring of the liver function. During the following days, bilirubin levels continued to increase, and 12 days after the initial symptoms (19 days after the beginning of the treatment), he developed grade I hepatic encephalopathy. Laboratorial exams showed an INR, creatinine, total bilirubin, AST, ALT and sodium levels of 4.4, 0.64 mg/dL, 37.3 mg/dL, 92 IU/L, 231 IU/L and 137 mmol/L, respectively. He exhibited a poor prognosis in ALF (drug-induced aetiology, time from jaundice to encephalopathy >7 days). Therefore, he was considered for priority cadaveric liver transplantation. After 3 days, he uneventfully underwent liver transplantation from a cadaveric donor. A total ischaemia time was 10 hours. He was discharged from the ICU on postoperative day 3, and he was discharged from the hospital on postoperative day 17. Histologic exam of the explanted liver revealed severe cholestasis, moderate portal and perivenular inflammatory infiltrates and extensive centrilobular necrosis, and these findings highly suggested of acetyl-tyrosine/caffeine/oxilofrine/salix-alba-induced ALF after DILI. At the time of report, he was alive and asymptomatic, with adequate liver graft function 31 months after the transplant. Ferreira GSA, et al. Acute Liver Failure Caused by Use of Fat Burner: A Case Report. Transplantation Proceedings 52: 1409-1412, No. 5, Jun 2020. Available from: URL: 803516035 http://doi.org/10.1016/j.transproceed.2020.01.072

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Reactions 21 Nov 2020 No. 1831