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Fulminant liver failure and transplantation after use of dietary supplements

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Clinical record

A 26-year-old Indigenous man presented with icteric sclera and skin on a background of 6 weeks of fatigue. He worked as a dockyard labourer, had no previous medical history, was not taking any medications regularly, did not smoke cigarettes or use any illicit substances, and did not drink alcohol to excess. Results of a physical examination were otherwise unremarkable — he had no features to suggest chronic liver impairment.

Blood tests conducted on admission showed a hepatocellular pattern of liver injury with mild derangement in synthetic function. Results of all other investigations were unremarkable (Box 1). Although not disclosed initially by the patient, repeat questioning revealed that, 10 weeks before presentation, he had used two dietary supplements for a 1-week period. These were a whey protein powder and a weight loss supplement containing 70% Garcinia cambogia. He had discontinued use of both products after consistently developing rigors shortly after ingesting them.

After admission, the patient’s liver synthetic function deteriorated (international normalised ratio rose to 2.5 and serum albumin level fell to 23 g/L). He also developed asterixis, without cognitive features of encephalopathy. Consequently, a liver biopsy was performed, with results of histopathology tests revealing submassive hepatic…

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