Abstract

A 51-year-old man from Puerto Rico with Child-Turcotte-Pugh Class C decompensated cirrhosis due to genotype 1a chronic hepatitis C was referred for worsening jaundice and diuretic-resistant ascites. He began experiencing symptoms of hepatic decompensation 5 months prior to referral with new-onset ascites and spontaneous bacterial peritonitis, evolving into diuretic-resistant ascites, increasing jaundice, and a MELD increase from 12 to 29. During his hospitalization, his MELD score increased to >40 from a rapidly increasing international normalized ratio (INR) and evolving type 1 hepatorenal syndrome. Clinically, the patient appeared quite well despite such a high MELD score. After an extensive pretransplant evaluation and exclusion of infection, he underwent successful orthotopic liver transplantation. After histologic examination of the explanted liver, he subsequently admitted to 5 months of daily use of a detoxifying supplement known as MaxOne (®), containing D-ribose- L-cysteine, consistent with a drug-induced acute-on-chronic liver failure. The use of complementary and alternative medicines and its potential for causing drug-induced liver injury and acute-on chronic liver failure requires a high index of suspicion and increased awareness among health care providers.

Links

Publisher Full Text

Authors

Im GY, Kazi S, Thung SN, Perumalswami PV

Institution

Division of Liver Diseases, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.

Source

Seminars in liver disease 31:4 2011 Nov pg 420-6

MeSH

Cysteine
Diagnosis, Differential
Drug-Induced Liver Injury
End Stage Liver Disease
Hepacivirus
Hepatitis C, Chronic
Hepatorenal Syndrome
Humans
Liver Cirrhosis
Liver Failure, Acute
Liver Transplantation
Male
Middle Aged
Thiazolidines

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22189981