S5743 When ‘Healthy’ Turns Harmful: Mushroom Coffee-Induced Acute Hepatitis

Introduction: Herbal coffee supplements have recently flooded the market despite lacking verifiable benefits or safety data. Adverse effects, particularly acute liver injury, have been increasingly reported. Mushroom toxicity is a well-recognized cause of hepatotoxicity; while Amanita species have been extensively studied for their risk of fulminant hepatitis, newer mushroom-derived ingredients have also been sporadically implicated in hepatocellular injury. We present a case of acute hepatitis induced by a mushroom-containing coffee supplement. Case Description/Methods: A 51-year-old man with a history of diabetes mellitus, bipolar disorder, ADHD, alcohol use, and cannabis use disorder presented with 2 weeks of abdominal pain, nausea, and non-bloody vomiting. He reported daily consumption of ‘mushroom coffee’ as a ‘colon cleanser’ for 3 weeks, initiated after an episode of gastroenteritis. His symptoms included nausea, intermittent vomiting, anorexia, changes in stool color ‘pale’, and approximately 20-pound weight loss. He denied recent alcohol use except for one beer a week prior. On examination, his vital signs were stable, with tenderness in the periumbilical region. Computed tomography imaging revealed severe hepatic steatosis. Laboratory tests showed elevated liver enzymes: aspartate aminotransferase (AST) 383 U/L, alanine aminotransferase 119 U/L, alkaline phosphatase 198 U/L, bilirubin total/direct 4.1/2.6 mg/dL, lipase 57 U/L, and international normalized ratio 1.2. gamma-glutamyl transferase was 2,090 and Ethanol level was <10 mg/dL. Viral hepatitis panel and anti-smooth muscle antibody (ASMA) testing were negative. Tumor markers revealed CA 19-9 of 522 U/mL and CEA of 3.5 ng/mL. MRCP demonstrated hepatic steatosis without masses or biliary obstruction. Given a high suspicion for toxin-induced liver injury, intravenous N-acetylcysteine for 72 hours and supportive care were initiated. Liver enzymes gradually declined to ALT 100, AST 67, ALP 171 and bilirubin total/direct 1.7/1.1 in one week and normalized over a month. Discussion: Toxin-induced liver injury is increasingly common due to widespread use of ‘natural’ supplements. While herbal mushrooms, such as Ganoderma lucidum (Lingzhi or Reishi), are known for their purported anti-inflammatory, antioxidant, and immunomodulatory effects, cases of acute hepatitis have been reported. This case highlights the potential risk of acute liver injury associated with Reishi mushroom ingestion and underscores the importance of considering supplement use in the evaluation of unexplained hepatitis. Discontinuation of the supplement led to clinical and biochemical recovery.