P1008 - A Rare Case of Drug-Induced Liver Injury Due to Sea Moss Consumption

Justin Chung, MD, Aboud Kaliounji, MD, Rebhi Rabah, MD, Michael Coles, MD, Savanna Thor, DO, MPH
SUNY Downstate Health Sciences University, Brooklyn, NY

Introduction: Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the western world. Its cause stems from a range of medications and nutraceuticals like sea moss. Sea moss has become increasingly popular for its health benefits, but reports have linked its consumption to nausea, vomiting and thyroiditis. Here, we present a case of liver injury after sea moss consumption.

Case Description/Methods: A 44-year-old woman with a past medical history of hyperlipidemia, alcohol use disorder, cerebrovascular accident (CVA), and pulmonary embolism presented to the emergency room for an ophthalmologic evaluation for retinal detachment which was ruled out. Physical exam was unremarkable, except for residual slurring of speech from prior CVA. Medications included atorvastatin, apixaban, and acetaminophen as needed. Incidentally, laboratory work showed markedly elevated liver enzymes, alkaline phosphatase (ALP), gamma glutamyl transferase (GGT), total and direct bilirubin (Table 1). Further work up including acetaminophen level, ethanol level, ceruloplasmin, iron studies, ANA, anti-smith antibody, anti-mitochondrial antibody, antiphospholipid antibody and hepatitis panel was unremarkable. Computed tomography (CT) of the abdomen and pelvis and magnetic resonance cholangiopancreatography (MRCP) were unremarkable. Liver biopsy showed mild, chronic inflammation of the portal tracts, sporadic inflammation with necrosis of the parenchyma without fibrosis, steatosis or cholestasis. Although she initially denied herbal supplementation, further questioning revealed frequent intake of fruit smoothies made with sea moss from a local Caribbean store.

Discussion: Over half of Americans use nutraceuticals which have become increasingly accessible due to lack of regulation. Recent studies estimated a 1.16 per 100,000 herbal-induced liver injury incidence, which accounts for 20% of hepatotoxicity cases and 13% of acute liver failure cases in America. While pathogenesis is not completely understood, it is believed that carrageenan, the active metabolite of sea moss, stimulates an inflammatory response through natural killer cells and natural killer T cell activation, ultimately triggering perforin molecules leading to liver damage. To our knowledge, this may be the first reported sea moss induced liver injury case. It emphasizes the importance of obtaining a nutraceutical use history and raises awareness about the potential liver injury risks associated with sea moss.



Disclosures:


Justin Chung, MD, Aboud Kaliounji, MD, Rebhi Rabah, MD, Michael Coles, MD, Savanna Thor, DO, MPH. P1008 - A Rare Case of Drug-Induced Liver Injury Due to Sea Moss Consumption, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.