S5550 Zinc Induced Liver Failure From Remedy to Ruin: Zinc Overload and Liver Failure

Introduction: While zinc is generally considered safe and is commonly associated with gastrointestinal upset, it rarely causes significant liver toxicity. Here, we present a case of acute liver failure from high-dose zinc supplementation. The case highlights the importance of considering supplement-induced hepatotoxicity in the differential diagnosis of liver injury. Case Description/Methods: A 34-year-old woman with no past medical history presented to the hospital with abdominal pain, dizziness, and extreme fatigue for several days. She reported associated hair loss and pale stools. She denied alcohol or acetaminophen use and had no history of chronic liver disease. On physical examination, the patient was jaundiced with scleral icterus. Laboratory tests revealed leukocytosis, hyperbilirubinemia, and transaminitis. A virology panel was negative. A computed tomography (CT) scan of the abdomen and pelvis showed a distended gallbladder with cholelithiasis and pericholecystic fat stranding, raising concern for acute cholecystitis. Gallbladder ultrasound and other imaging were consistent with these findings but did not show choledocholithiasis or bile duct dilation. Despite the absence of biliary obstruction, the patient’s transaminitis and hyperbilirubinemia worsened. Endoscopic retrograde cholangiopancreatography showed no occlusion or contrast leak. A liver ultrasound and nuclear medicine scan revealed findings consistent with severe liver disease. Upon further questioning, the patient revealed she had taken high-dose zinc supplements for a cold for 3 weeks before the onset of her symptoms. An autoimmune workup was performed, including serologic testing and a liver biopsy, to rule out autoimmune hepatitis. Empiric methylprednisolone was initiated. The initial liver biopsy revealed submassive necrosis with only 30% viable hepatocytes. A repeat biopsy one week later showed improved liver parenchyma, while her liver enzymes began to downtrend and returned to normal. Discussion: Given that no other cause had been identified despite a thorough workup, her liver failure was attributed to zinc overuse. Although zinc supplementation is generally considered benign and used for its immune benefits, excessive intake can lead to serious side effects, like acute liver failure. While hepatotoxicity from zinc is rare, it remains a potential cause, given its increasing use and popularity. This case emphasizes how important it is to recognize that even commonly used supplements can cause serious conditions like liver failure.