A 23 year old young male with history of taking gym supplements for weight gain was presented with the history of jaundice and itching for one month. There was no history of fever, loose stools and vomiting. No prior history of jaundice or liver disease. routine investigation revealed deranged liver function (T.bil -27.8 mg/dl, D.bil. 26.0 mg/dl, AST – 74 U/L, ALT -44 U/L, ALP 315U/L, GGT- 37U/L). Laboratory reports revealed normal renal function tests & negative viral markers. Autoimmune profile was also negative. USG Abdomen showed hepatomegaly. There was no evidence of Gall bladder stone in the USG finding. MRCP was done in the next line of investigation, which was also turned out to be normal. In the absence of other common possible cause of liver injury it was likely to be a case of gym supplement induced liver injury. In the next diagnostic workup, patient was planned for liver biopsy. Biopsy showed cholestatic pattern of acute liver injury, queried drug induced liver injury.

Patient was started on the oral steroid (Wysolone 1mg/kg) and other supportive medicines.

Following supportive medicines started for the gym supplement induced liver injury :

Tab UDCA 450 BD (Ursodeoxycholic Acid), Tab Nusam 400 BD (S-Adenosyl-L-Methionine), Tab Atarax 25mg TDS (Hydroxyzine), Cholestyramine sachet thrice daily (Cholestyramine)

Subsequently patient’s liver function tests showed improving trend with decreased T. Bil. After five days of hospitalization patient was discharged on oral steroids and called for follow up after five days with liver function test report.

Currently patient is improved completely with no symptoms and normal liver function tests.