S5850 Detox or Danger: The Unseen Risks of Herbal Supplements on Liver Health

Introduction: Turkey tail mushrooms contain polysaccharides that modulate immune-mediated damage, reishi mushrooms’ ganoderic acid interferes with cytochrome P450 enzymes, and kombucha’s organic acids can overwhelm hepatic detoxification pathways. Together, they may amplify oxidative stress and hepatic injury, especially in patients with predisposing factors. Unfortunately, supplement use is frequently underreported and underrecognized in routine clinical assessments, contributing to delayed diagnosis and treatment. Case Description/Methods: A 40-year-old woman with a history of cholelithiasis and obesity presented with severe epigastric pain, nausea, and vomiting 2 days after taking her weekly Semaglutide injection, which she had tolerated well for the past year. She denied recent illness, travel, or use of antibiotics or alcohol. She reported taking turkey tail and reishi mushroom supplements daily for the past month, along with kombucha. Labs showed hepatocellular liver injury (R-factor 14.9): aspartate aminotransferase (AST) 831 U/L, alanine aminotransferase (ALT) 632 U/L, alkaline phosphatase 88 U/L, total bilirubin 1.9 mg/dL, international normalized ratio 1.0. Lipase was negative. Prior liver function tests were unremarkable. Acute hepatitis and chronic liver serological workup were unrevealing. Imaging (CT, MRCP, US) showed cholelithiasis, without evidence of choledocholithiasis, acute cholecystitis, or vascular obstruction. Given the temporal association and exclusion of other causes, supplement-induced hepatotoxicity was strongly suspected. The patient was advised to discontinue all supplements and kombucha, and she received supportive care with intravenous fluids, antiemetics, and analgesia. By day 3, she showed no signs of encephalopathy and her transaminases improved markedly (AST 98 U/L, ALT 365 U/L, total bilirubin 0.6 mg/dL), consistent with resolving liver injury. She was discharged with outpatient hepatology follow-up. Discussion: Herbal and dietary supplements account for approximately 20% of DILI cases, yet awareness remains low and in severe cases can lead to fulminant liver failure. Moreover, supplements are not FDA regulated. This case underscores the importance of thorough history-taking in patients with unexplained liver enzyme elevations. Integrating supplement screening into routine clinical practice is essential in the current era of widespread over-the-counter supplement use. Early identification and discontinuation of hepatotoxic agents can prevent progression to acute liver failure and facilitate timely recovery.