P1034 - Tetrahydrocannabinol-Containing Sleep Aid Supplements: An Unexpected Cause of Drug-Induced Liver Injury

Xheni Deda, MD¹, Alexander K. Malik, MD², Muhammad Nadeem. Yousaf, MD³, Deepthi Rao, MD¹, Ahmad Ali, MD^1
1Missouri University Hospital, Columbia, MO; ²Summa Health System, Akron, OH; ³University of Missouri-Columbia, Columbia, MO

Introduction: Marijuana is the most commonly used federally illicit drug in the United States. Tetrahydrocannabinol (THC) is the active chemical component responsible for marijuana's desirable clinical effects. THC-containing products are often used without a prescription from a licensed medical provider for the treatment of several medical conditions, including insomnia. Certain THC-containing products marketed in the U.S. are formulated with other ingredients which may potentially cause liver failure. Here we report a case of liver injury due to the use of sleep aid pills marketed in the U.S. as Midnight Drop.

Case Description/Methods: A 53-year-old woman presented to our hepatology clinic for evaluation of elevated liver enzymes. Previously her liver biochemical profile was normal. On presentation, she reported right upper quadrantnabdominal pain. Medical history was pertinent for alcohol use of 2-3 glasses of wine daily, and family history significant for autoimmune diseases including rheumatoid arthritis and giant cell arthritis. She reported taking THC supplements for insomnia. Liver enzymes on initial presentation are shown below (Table 1). Abdominal ultrasound showed gallbladder sludge but otherwise a liver with normal hepatic parenchyma. Our initial impression was liver injury secondary to alcohol use, autoimmune hepatitis, and drug-induced liver injury (DILI). Subsequently, blood testing was positive only for antinuclear antibodies ( >1:1280). A liver biopsy showed hepatic parenchyma with multifocal centrilobular hepatocyte dropout and portal/pericentral ceroid-laden macrophages, suggestive of resolving recent liver injury and mild nonspecific lobular and portal inflammation (Figure 1). Based on the biopsy findings, the ingredients of the THC-containing supplement were analyzed and found to contain corydalis extract, which has been identified as a cause of liver injury in very recent literature. On further questioning, the onset of the abdominal pain and liver enzyme elevations correlated very well with the start of the THC supplement, so we recommended stopping taking it. Repeat liver enzymes following discontinuation of the Midnight drops showed significant improvement in liver enzymes as demonstrated below (Table 1).

Discussion: Here we present a case of liver injury due to THC supplements. Although THC supplements have not been reported to be hepatotoxic, clinicians should be aware that different formulations might include hepatotoxic ingredients.




Disclosures:


Xheni Deda, MD¹, Alexander K. Malik, MD², Muhammad Nadeem. Yousaf, MD³, Deepthi Rao, MD¹, Ahmad Ali, MD¹. P1034 - Tetrahydrocannabinol-Containing Sleep Aid Supplements: An Unexpected Cause of Drug-Induced Liver Injury, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.