Open AccessNiacin‐Induced Anicteric Microvesicular Steatotic Acute Liver Failure
Author(s) -
Leung Kenneth,
Quezada Michael,
Chen Zhengshan,
Kanel Gary,
Kaplowitz Neil
Publication year - 2018
Publication title -
hepatology communications
Language(s) - English
Resource type - Journals
ISSN - 2471-254X
DOI - 10.1002/hep4.1253
Subject(s) - niacin , steatosis , coagulopathy , medicine , encephalopathy , gastroenterology , liver function tests , liver function , hepatic encephalopathy , fatty liver , cirrhosis , disease
Niacin (vitamin B3) is available as a prescription medication and over‐the‐counter supplement. Although it is well known for its vasodilatory effect, it has also been associated with mild hepatotoxicity and, rarely, acute liver failure. We present the case of a 74‐year‐old Hispanic woman who developed acute liver failure (anicteric encephalopathy and coagulopathy) after her home dose of immediate‐release niacin was replaced with an extended‐release formulation during an inpatient hospital stay. This is the first reported case of niacin toxicity associated with a histopathologic finding of diffuse microvesicular steatosis. This unique phenotype strongly implicates mitochondrial impairment as a mechanism of niacin‐induced hepatotoxicity.