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Aldyab M, Ells PF, Bui R, et al. Kratom-Induced Cholestatic Liver Injury Mimicking Anti-Mitochondrial Antibody-Negative Primary Biliary Cholangitis: A Case Report and Review of Literature. Gastroenterology Res. 2019;12(4):211-215doi: 10.14740/gr1204.
Aldyab, M., Ells, P. F., Bui, R., Chapman, T. D., & Lee, H. (2019). Kratom-Induced Cholestatic Liver Injury Mimicking Anti-Mitochondrial Antibody-Negative Primary Biliary Cholangitis: A Case Report and Review of Literature. Gastroenterology research, 12(4), 211-215. https://doi.org/10.14740/gr1204
Aldyab, Mahmoud, et al. "Kratom-Induced Cholestatic Liver Injury Mimicking Anti-Mitochondrial Antibody-Negative Primary Biliary Cholangitis: A Case Report and Review of Literature." Gastroenterology research vol. 12,4 (2019): 211-215. doi: https://doi.org/10.14740/gr1204
Aldyab M, Ells PF, Bui R, Chapman TD, Lee H. Kratom-Induced Cholestatic Liver Injury Mimicking Anti-Mitochondrial Antibody-Negative Primary Biliary Cholangitis: A Case Report and Review of Literature. Gastroenterology Res. 2019 Aug;12(4):211-215. doi: 10.14740/gr1204. Epub 2019 Aug 25. PMID: 31523332; PMCID: PMC6731044.
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Gastroenterology Res. 2019 Aug;12(4):211-215. doi: 10.14740/gr1204. Epub 2019 Aug 25.

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

Gastroenterology research

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

Affiliations

  1. Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY 12208, USA.
  2. Gastroenterology, Albany Medical College, Albany, NY 12208, USA.
  3. Pathology, Bassett Healthcare Network, Cooperstown, NY 13326, USA.

PMID: 31523332 PMCID: PMC6731044 DOI: 10.14740/gr1204

Abstract

Kratom is an herbal supplement used to relieve chronic pain or opioid withdrawal symptoms. Recent news articles covering adverse effects associated with kratom use have brought attention to its organ toxicities. Reports of kratom-induced hepatic toxicity are limited and only three case reports of kratom-induced liver injury with histopathologic examination of the liver biopsies are available. A 40-year-old female presented with symptoms of mixed cholestatic and hepatocellular liver injury without clear etiology. The laboratory and imaging workup suggested possibilities of autoimmune hepatitis, autoimmune hepatitis-primary biliary cholangitis (PBC) overlap syndrome, or drug-induced liver injury. Autoantibodies including anti-mitochondrial antibody (AMA) were negative. Liver biopsy showed granulomatous hepatitis with prominent duct injury, suggestive of AMA-negative PBC. She subsequently was referred to a hepatologist and a history of recent kratom use was finally revealed. Kratom was discontinued and the symptoms improved. Kratom-induced hepatic toxicity may manifest with variable biochemical and clinical abnormalities. Histologically, it may mimic AMA-negative PBC. Our case highlights the importance of thorough history taking, interdisciplinary approach and communication for optimal patient care.

Keywords: Biopsy; Cholestasis; Granuloma; Kratom; Liver

Conflict of interest statement

None to declare.

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