Kratom-Induced Cholestatic Liver Injury Mimicking Anti-Mitochondrial Antibody-Negative Primary Biliary Cholangitis: A Case Report and Review of Literature

Aldyab, Mahmoud; Ells, Peter; Bui, Rosa; Chapman, Timothy D.; Lee, Hwajeong

doi:10.14740/gr1204

Cited by 22 publications

(17 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lymphocytic cholangitis, a typical feature of PBC and unusual medication-injury finding, raised initial concern for underlying early stage PBC. This is of lesser concern given her negative antinuclear antibody and AMA status, trend toward rapid resolution of liver enzymes, and a case report by Aldyab et al[ 10 ] in 2019 that reported a case of kratom toxicity with granulomatous cholangitis (another form of florid duct lesion) that mimicked PBC. This was from a 40-year-old female presenting with liver injury after Kratom use who initially perceived to have AMA-negative PBC but diagnosed with Kratom induced liver injury after rapid normalization of liver enzymes.…”

Section: Discussionmentioning

confidence: 99%

Kratom induced severe cholestatic liver injury histologically mimicking primary biliary cholangitis: A case report

Gandhi¹,

Ahuja²,

Quade³

et al. 2020

WJH

View full text Add to dashboard Cite

BACKGROUND 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. CASE SUMMARY 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. CONCLUSION 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.

show abstract

Section: Discussionmentioning

confidence: 99%

Kratom induced severe cholestatic liver injury histologically mimicking primary biliary cholangitis: A case report

Gandhi¹,

Ahuja²,

Quade³

et al. 2020

WJH

View full text Add to dashboard Cite

show abstract

“…Kratom use has been often linked to liver toxicity. Kratom has been associated with biliary cholangitis and cholestasis in several cases (67,(103)(104)(105)(106)(107)(108)(109)(110) and with one case of hepatomegaly (111), but also with acute hepatitis (112). Mitragynine inhibits hepatic and intestinal cytochrome P450 3A activities (113) and hepatic microsomal CYP2D6 (114), thus increasing blood levels of other concomitantly administered drugs that are metabolized by these isoenzymes, that is, most psychiatric drugs.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant

Vento

Persis²,

Filippis³

et al. 2021

Front. Psychiatry

View full text Add to dashboard Cite

Kratom or Mitragyna speciosa (Korth.) is an evergreen tree of the coffee family native to South-East Asia and Australasia. It is used by locals recreationally to induce stimulant and sedative effects and medically to soothe pain and opiate withdrawal. Its leaves are smoked, chewed, or infused, or ground to yield powders or extracts for use as liquids. It contains more than 40 alkaloids; among these, mitragynine and 7-hydroxymitragynine are endowed with variable mu, delta, and kappa opioid stimulating properties (with 7-hydroxymitragynine having a more balanced affinity), rhynchophylline, which is a non-competitive NMDA glutamate receptor antagonist, but is present in negligible quantities, and raubasine, which inhibits α1-adrenceptors preferentially over α2-adrenceptors, while the latter are bound by 7-hydroxymitragynine, while mitragynine counters 5-HT2A receptors. This complexity of neurochemical mechanisms may account for kratom's sedative-analgesic and stimulant effects. It is commonly held that kratom at low doses is stimulant and at higher doses sedative, but no cut-off has been possible to define. Long-term use of kratom may produce physical and psychological effects that are very similar to its withdrawal syndrome, that is, anxiety, irritability, mood, eating, and sleep disorders, other than physical symptoms resembling opiate withdrawal. Kratom's regulatory status varies across countries; in Italy, both mitragynine and the entire tree and its parts are included among regulated substances. We describe the case of a patient who developed anxiety and dysphoric mood and insomnia while using kratom, with these symptoms persisting after withdrawal. He did not respond to a variety of antidepressant combinations and tramadol for various months, and responded after 1 month of clomipramine. Well-being persisted after discontinuing tramadol.

show abstract

“…Regretfully, some otherwise promising and promotional HILI cases did not benefit from causality assessment by RUCAM (Table 5) as shown in reports originating from Argentina (114), Austria (115), Belgium (116), Canada (117,118), China (107,(119)(120)(121), France (121,122), Germany (118,(123)(124)(125)(126)(127)(128)(129)(130)(131), Italy (132,133). Japan (134), the Netherlands (135), New Zealand (136), South Africa (137), Thailand (138), and the US (139)(140)(141)(142)(143)(144)(145)(146)(147)(148)(149)(150)(151)(152)(153)(154). RUCAM could have provided substantial support for published conclusions and provided more power to HILI related issues.…”

Section: Published Hili Cases Lacking Causality Assessment By Rucammentioning

confidence: 99%

Herb-induced liver injury (HILI) with 12,068 worldwide cases published with causality assessments by Roussel Uclaf Causality Assessment Method (RUCAM): an overview

Teschke¹,

Eickhoff²,

Schulze³

et al. 2021

Transl Gastroenterol Hepatol

View full text Add to dashboard Cite

Herbal products including herbal medicines are worldwide used in large amounts for treating minor ailments and for disease prevention. However, efficacy of most herbal products has rarely been well documented through randomized controlled trials in line with evidence-based medicine concepts, which could be used to estimate the benefit/risk ratio. Instead, much better documented are adverse reactions such as liver injury associated with the consumption of some herbal products, so called herb-induced liver injury (HILI), which represents a clinical challenge. In order to establish HILI as valid diagnosis, the use of a diagnostic algorithms such as Roussel Uclaf Causality Assessment Method (RUCAM) is widely recommended, although physicians in some countries are reluctant to use RUCAM for their HILI cases.This review on worldwide HILI and RUCAM, developed as part of the artificial intelligence ideas, reveals that China is the leading country with 24 publications on HILI cases that were all assessed for causality using RUCAM, followed by Korea with 15 reports, Germany with 9 reports, the US with 7 reports, and Spain with 6 reports, whereas the remaining countries provided less than 4 reports. The total number of assessed HILI cases is 12,068 worldwide derived from 80 publications but in each report HILI case numbers were variable in a range from 1 up to 6,971. This figure compares with 46,266 cases of drug-induced liver injury (DILI) published worldwide from 2014 to early 2019 also assessed for causality by RUCAM. The original version of RUCAM was validated and established in 1993 and updated in 2016 that should be used in future HILI cases. RUCAM is an objective, structured, and validated method, specifically designed for liver injury. It is a scoring system including case data elements to be assessed and scored individually to provide a final score in five causality gradings. Among the 11,404/12,068 HILI (94.5%) cases assessable for evaluation, causality gradings were highly probable in 4.2%, probable in 15.5%, possible in 70.3%, and unlikely or excluded in 10.0%. To improve the future reporting of RUCAM based HILI cases, recommendations include the strict adherence to instructions outlined in the updated RUCAM and, in particular, to follow prospective data collection on the cases to ensure completeness of case data. In conclusion, RUCAM can well be used to assess causality in suspected HILI cases, and additional efforts are now required to increase the quality of the reported cases.

show abstract

Kratom-Induced Cholestatic Liver Injury Mimicking Anti-Mitochondrial Antibody-Negative Primary Biliary Cholangitis: A Case Report and Review of Literature

Cited by 22 publications

References 27 publications

Kratom induced severe cholestatic liver injury histologically mimicking primary biliary cholangitis: A case report

Kratom induced severe cholestatic liver injury histologically mimicking primary biliary cholangitis: A case report

Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant

Herb-induced liver injury (HILI) with 12,068 worldwide cases published with causality assessments by Roussel Uclaf Causality Assessment Method (RUCAM): an overview

Contact Info

Product

Resources

About