S5944 Phosphatidylcholine-Induced Transaminitis—How One Patient’s Longing to Lower Lipids Left Her Liver Languishing

Introduction: Phosphatidylcholine (PC) is a polyunsaturated fatty acid compound that comprises 40%-60% of human cellular membranes. Intravenous supplementation of PC has no FDA-approved indications and is not covered by insurance, but is touted as a treatment for many diseases including hyperlipidemia, atherosclerosis, dementia, and metabolic dysfunction-associated steatotic liver disease. The most popular brand of PC formulation costs at least $250 per infusion. Case Description/Methods: We present a 69-year-old woman with a past medical history of diabetes mellitus, myocardial infarcts, and hyperlipidemia who was brought from a medical spa to the Emergency Department for sharp, 10/10, right-sided pain immediately following her tenth infusion of PC. Abdominal exam revealed mild tenderness to palpation in all 4 quadrants. Denied recent travel, drugs, nicotine, alcohol use, and any other new medications, vitamins, or supplements. Computed tomography angiography and right upper quadrant ultrasound with doppler were completed. They were remarkable for a 17 cm liver with increased echogenicity suggestive of steatosis, but negative for gallstones, duct dilation, or advanced atherosclerotic disease in the abdominal vessels. Labs revealed aspartate aminotransferase (AST) 1,868, alanine aminotransferase (ALT) 1,255, alkaline phosphatase 140, with lipase, lactic acid, total bilirubin, and acetaminophen level within normal limits. Hepatitis panel, antinuclear antibody, antimitochondrial, anti-neutrophil cytoplasmic antibodies, antismooth muscle, liver kidney microsomal antibodies, and HIV were negative. After an overnight stay the patient’s abdominal pain resolved, transaminases began to downtrend, and she was discharged. She was counseled to discontinue PC infusions, repeat labs in a week, and follow up with her primary care provider. Discussion: Patient did not resume PC infusions and liver function tests demonstrated improvement 8 days (AST 21, ALT 134) and 23 days after presentation (AST 14, ALT 21). Total cholesterol (242 - >190), LDL (166 - >113), and HDL decreased (54 - >51) over a 4-month period, 2 of which she was receiving PC along with continuing niacin. While it cannot be proven with certainty that the newly started PC infusions caused our patient’s presentation, all other common etiologies were ruled out, including ischemic, infectious, biliary, autoimmune, and use of other drugs. This is the first known report of severe transaminitis secondary to PC infusions. Patients should be cautious about using non-FDA approved treatments and physicians should continue to diligently ask patients about use of non-prescribed vitamins, supplements, or treatments.