S2637 Kombucha-Induced Liver Injury

Introduction: Kombucha is a beverage prepared from the cultures of bacteria and yeast, which has described hepatoprotective properties.1 There are few cases in which hepatotoxicity has been described. 2 We present a rare case of kombucha induced liver injury. Case Description/Methods: A healthy 33-year-old female presented to urgent care with cervical lymphadenopathy, rash, and fever to 102F. She tested negative for COVID-19, streptococcus, and mononucleosis. One week later, she developed abdominal pain and jaundice, prompting her presentation to the emergency department. Here, labs showed an AST 223 IU/L, ALT 270 IU/L, ALP 713 IU/L, total bilirubin 11.4 mg/dL (direct 7.7 mg/dL), albumin 2.6 g/dL, GGTP 202 IU/L, and normal coagulation studies. Infectious work-up including hepatitis A, B, C, D, and E, CMV, EBV, HIV, stool ova and parasites, and blood cultures which were all negative. Additional metabolic and immunologic workup was all negative. Abdominal ultrasound showed no evidence of biliary ductal dilatation or obstruction, and MRCP was normal. Liver biopsy is depicted in image 1. She reported consuming 12 ounces of kombucha daily for 5 months prior to presentation, and denied prescription, over the counter, and herbal medications. She was advised to abstain from kombucha, which resulted in resolution of her liver injury. Discussion: In the absence of serologic, radiographic, and histologic evidence of autoimmune hepatitis, viral or parasitic infection, obstructive pathology, and resolution of liver enzymes with cessation of imbibement, Kombucha induced liver toxicity was diagnosed as the reason for cholestatic jaundice. Her RUCAM score of 7 suggests a “probable” causality of kombucha ingestion as the etiology of liver injury.3 We present this case to enhance awareness of potential hepatotoxicity from kombucha and to encourage research into the mechanism by which this beverage can cause hepatotoxicity. (Figure Presented).