Turmeric associated liver injury (DILI) with susceptible HLA

We present a 35-year-old Caucasian woman that was sent to the Hepatology clinics of our hospital in December 2023 for new onset jaundice. Without significant past medical history, the patient presented with bloating and dyspepsia for a week. No neurological abnormalities were found. She reported occasional alcohol intake, denying other drug consumption. No recent vaccination. She reported taking an over-the-counter supplement containing turmeric (tablet with 60 mg of curcumin and 10mg of black pepper) twice daily for 2 months with the aim of speedy recovery after CrossFit. Blood analysis was remarkable for alanine transaminase (ALT) 2230 U/L, aspartate transaminase (AST) 916U/L, total bilirubin 10.5 mg/dl, and direct bilirubin 8.0mg/dl. Coagulation within range. Computed tomography revealed hepatic hemangiomas and cysts without biliary tract dilatation. Further laboratory workup including acute hepatitis serologies (VHA, VHB, VHC, VHE, HSV, VVZ, EBV, CMV and Parvovirus) and autoimmune profile were unremarkable, except for being carrier of HLA DRB1*04 and HLA B35:01*in genetical studies. Due to probable DILI diagnose, 8 points in CIOM/RUCAM scale, she was advised to stop Turmeric. She was followed up in our Hepatology clinics and observed how liver enzymes progressively down-trended. Our patient remained asymptomatic with normal liver enzymes three months after stopping the supplement intake.