Published online Oct 27, 2020. doi: 10.4254/wjh.v12.i10.863
Peer-review started: May 20, 2020
First decision: July 29, 2020
Revised: August 2, 2020
Accepted: August 26, 2020
Article in press: August 26, 2020
Published online: October 27, 2020
Processing time: 155 Days and 6.8 Hours
Kratom is a psychoactive substance that is isolated from the plant Mitragyna speciosa. The leaves can be chewed fresh or dried, smoked, or infused similar to herbal teas. The plant leaves have been used by natives of Southeast Asia for centuries. The substance has been used for its stimulant activity at low doses, and as an opium substitute at higher doses due to a morphine like effect.
A 37-year-old female with a history of depression and obesity (body mass index: 32) presented to emergency room with a week-long history of nausea, decreased appetite, fatigue, and two days of jaundice. On admission bilirubin was markedly elevated. Her condition was thought to be due to consumption of Kratom 2 wk before onset of symptoms. Liver biopsy showed changes mimicking primary biliary cholangitis. Patient’s symptoms and jaundice improved quickly.
The use of Kratom has been on the rise in recent years across the United States and Europe. Several case reports have associated adverse health impact of Kratom-containing products including death due to its ability to alter levels of consciousness. Only a few case reports have highlighted the hepatotoxic effects of Kratom. Even fewer reports exist describing the detailed histopathological changes.
Core Tip: Kratom induced liver injury is an important differential diagnosis for physicians to consider in any patient presenting with acute liver injury. As observed in our patient, this manifestation of Kratom consumption may occur even at low doses. Further, this case report demonstrates that a thorough history is essential for an accurate and timely diagnosis. Patients may consider dietary and herb supplements to be natural and risk-free products, not realizing the potential for harm. In addition to asking their patients about consumption of any supplements, it is imperative that physicians update themselves so as to be able to discuss the benefits and risks, and counsel their patients effectively. Identifying use of supplements helps in early diagnosis and treatment, while also preventing future harm. From the pathology perspective, biliary changes associated with Kratom injury can mimic primary biliary cholangitis.