S5578 Turmeric—The Golden Spice That May Deceive!

Introduction: Drug induced liver injury (DILI) is commonly due to prescription medications like amoxicillin. However, supplements are now an emerging cause of DILI. Turmeric is thought to be safe with anti-inflammatory and antioxidant properties. Turmeric contains curcuminoids that have been shown to inhibit leukotriene synthesis that theorized to inhibit intracellular kinases, an antineoplastic property. Despite these benefits, there are case reports and small studies that suggest acute liver injury (ALI). Our case of DILI is unique as it was most likely induced by high bioavailability turmeric supplementation. Case Description/Methods: A 48-year-old man with history of alcohol use presented to the Emergency Department due to yellowing of his skin. Over the past 2 weeks, he reported general malaise, dark urine, light colored stool, and yellowing of the skin and eyes. He started taking supplements turmeric 1,000 mg twice a day and beet root 1,000 mg daily 1 month ago but stopped taking them a week ago. He denied recent travel, sick contacts, new medications, and pet exposure. He has not had any alcohol use in the last 2 years. Vital signs were stable and physical exam remarkable for jaundice and scleral icterus. Labs: aspartate aminotransferase 1,516 and alanine aminotransferase 2,418, total bilirubin 16.1, alkaline phosphatase 155, complete blood count was unremarkable. Hepatitis B, C, and A serologies, syphilis RPR, HIV, VZV IgM, ANA, ASMA, cerulopasmin, CMV, LKM, ethanol, acetaminophen, UDS were all unremarkable. Abdominal ultrasound and CT abdomen showed normal liver morphology with patent main portal vein, no signs of biliary duct dilation or cholecystitis. Turmeric was discontinued and labs normalized after weeks. Discussion: This is a unique case of turmeric associated DILI. Turmeric induced DILI can show up after weeks to months. Injury is a hepatocellular pattern, and the mechanism may be due to interaction of curcuminoids with HLA B 3501, which leads to an autoimmune - like reaction. The HLA B 3501 allele is also linked to liver injury by green tea. In contrast, beet root supplements have not previously been identified as a cause of ALI. Fortunately, most causes of turmeric induced DILI resolve within a few months of stopping turmeric. This rare cause of hepatic injury emphasizes the importance of broad differentials and comprehensive medication reconciliation, including OTCs and supplements. With the popularity of turmeric supplementation rising, this may become a more common occurrence.