S5674 Curcumin-Containing Supplement-Induced Liver Injury: A Case Report

Introduction: Drug-induced liver injury (DILI) is a leading cause of acute liver failure in the United States. Over the past 2 decades, herbal and dietary supplements have been increasingly implicated, accounting for nearly 20% of cases. Curcumin, turmeric’s active component, has been associated with hepatocellular injury in several case series. Case Description/Methods: A 31-year-old woman with recurrent urinary tract infections was started on TMP/SMX. Labs from the same visit showed LFTs >40× ULN, total bilirubin 12.6 mg/dL, and direct bilirubin 10.2 mg/dL. She was asymptomatic with scleral icterus. Imaging showed gallbladder edema. With improving labs, she was treated for possible acalculous cholecystitis or possibly from a passed stone. She re-presented 10 days later with nausea, vomiting, and persistent jaundice. Liver function tests were rising again. Imaging showed unchanged gallbladder edema. Extensive work-up, including viral hepatitis, α-1 antitrypsin, ceruloplasmin, and phosphatidylinositol, was negative. anti-smooth muscle antibodies was mildly elevated at 36 U/mL (normal <20). She denied alcohol, nonsteroidal anti-inflammatory drug, or acetaminophen use but reported recent intake of a curcumin-based urinary health supplement. Liver biopsy on day 14 showed panlobular necroinflammatory activity with interface hepatitis, eosinophils, and stage 2–3 periportal fibrosis. No steatosis or bile duct injury was seen. She was treated for DILI vs autoimmune hepatitis (given anti-smooth muscle antibodies) with a steroid taper and discontinuation of supplement. Liver tests remained stable off steroids at 1- and 4-month follow-up. Her RUCAM score was 10, supporting a highly probable diagnosis of DILI. Discussion: This case highlights the hepatotoxic potential of curcumin supplements, which may contain ∼30-fold higher concentrations per gram than natural turmeric. Clinicians should maintain a high index of suspicion for supplement-related liver injury and educate patients that “natural” does not mean safe.