S2544 An Alternative Homeopathic Treatment of IV Hydrogen Peroxide Causing Significant Drug-Induced Liver Injury

INTRODUCTION: Hydrogen peroxide is considered a reactive oxygen species that induces cell damage via lipid peroxidation, corrosion, and oxygen gas formation. Homeopathic remedies have utilized hydrogen peroxide for treatment of various ailments. We present a unique case of drug induced liver injury secondary to the administration of intravenous hydrogen peroxide as a homeopathic aliment. CASE DESCRIPTION/METHODS: 61 year old african american female who presented to the hospital for confusion. History revealed she was seen 4 months prior for drug induced liver injury from hydrogen peroxide. She was receiving intravenous hydrogen peroxide as a therapy for her chronic kidney disease from her homeopathic physician. Patient did not have a prior history of cirrhosis. On admission, labs revealed a total bilirubin of 13.4, direct bilirubin 8.2, alkaline phosphatase 255, AST 12, ALT 11 and INR of 1.5. Peak ammonia level was recorded at 50. The calculated MELD score was 35. Patient was placed on lactulose, rifaximin, acetylcysteine and ursodiol. Doppler ultrasound was performed showing cirrhosis with small volume ascites and splenomegaly. Urine drug screen, phosphatidylethanol, viral hepatitis panel, HIV, RPR, ANA, mitochondrial antibody and anti smooth muscle antibody were negative. Ceruloplasmin was measured at 77 and ferritin at 476. CMV IgG antibody was detected. Additionally EBNA IgG and VCA IgG were detected with a negative VCA IgM. Liver biopsy results were reviewed confirming drug induced liver injury due to the extensive amount of neutrophils and poorly formed granulomas . Her mentation improved and ammonia trended to 27. She was discharged for follow up with hepatology for transplant reevaluation. DISCUSSION: Hydrogen peroxide has been previously used by homeopathic practitioners for treatment of various diseases including cancer, infections, arthritis and arterial disease. Toxicity from hydrogen peroxide most commonly includes mucosal burning/blistering, hemorrhagic gastritis, organ rupture and air emboli. Our patient experienced drug induced liver injury following intravenous hydrogen peroxide use. On literature review, there were no prior reported cases of liver failure from hydrogen peroxide. Treatment included acetylcysteine in attempts to reduce ROS. Healthcare professionals should be aware of the hepatotoxic effects of hydrogen peroxide, and should refrain from using it as a homeopathic aliment.Figure 1.: H&E stain which depicts Lobular Inflammation with neutrophils.Figure 2.: H&E stain shows rare poorly formed granuloma with adjacent neutrophilic lobular inflammation.Figure 3.: H&E stain with a granuloma seen in higher magnification.