Unbound MEDLINE

A maxed-out liver: a case of acute-on-chronic liver failure.

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.

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  • 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