S5817 An Unusual Case: Reishi Mushroom Supplement Unveiling Autoimmune Hepatitis

Introduction: Reishi mushroom (Ganoderma lucidum) is an herbal supplement that is often touted for its potential immune-boosting and anti-inflammatory properties. However, the use of herbal supplements is not without risks and adverse effects can occur. In our literature search, there have been 3 cases, one fatal, of severe hepatocellular injury following reishi mushroom ingestion. We present a case of autoimmune hepatitis unmasked by reishi supplementation. Case Description/Methods: A 42-year-old woman presented with abdominal pain, jaundice, dark urine, and pale stools approximately 1 month after initiating reishi mushroom supplements for acne. No other hepatotoxic prescriptions were identified. Initial labs showed elevation in LFTs (aspartate aminotransferase 1361, alanine aminotransferase 1644, alkaline phosphatase 186, and bilirubin 6.6). Viral hepatitis panels and drug screens were negative. Imaging revealed periportal and gallbladder wall edema, along with a likely hepatic hemangioma. Further labs tests showed positive ANA (1:320); although other antibodies (ASMA, LMK-1, AMA) were negative. Liver biopsy revealed severe acute hepatitis with parenchymal injury. Initial treatment with N-acetylcysteine (NAC) was ineffective. Given persistent dysfunction, Prednisone 40 mg daily was initiated after biopsy, resulting in significant improvement in LFTs. Post-discharge, attempts to taper off steroids led to a rise in LFTs, requiring re-initiation of high dose steroids. Azathioprine was trialed but not tolerated. The patient remains on corticosteroids. Discussion: Reishi mushroom’s hepatotoxic potential remains under-investigated. In this case, the patient developed acute liver injury following the ingestion of reishi mushroom supplements. The temporal relationship between supplement intake and the onset of symptoms suggests a causal link. The patient's recurrent rise in LFTs following steroid taper strongly suggests the presence of an underlying autoimmune hepatitis rather than isolated herb-induced hepatotoxicity. This case highlights the importance of prompt recognition and intervention in suspected herb-induced hepatotoxicity. Further research is needed to establish safety guidelines for reishi use.