Case Report
Copyright ©The Author(s) 2020.
World J Hepatol. Oct 27, 2020; 12(10): 863-869
Published online Oct 27, 2020. doi: 10.4254/wjh.v12.i10.863
Table 1 Patient’s liver function labs from the day after admission until the day of hospital discharge
HD1HD2HD3HD4HD5Six days post- dischargeNormal values
Total bilirubin (mg/dL)10.312.014.517.219.55.7< 1.0
Alkaline phosphatase (U/L)67267774481783950750-160
ALT (U/L)5785856006085913230-30
AST (U/L)4554614374013851010-40
Table 2 Kratom-induced hepatotoxicity with review of literature in patients with liver biopsy
Ref.Age, sexClinical findingsForm, amount, duration of Kratom consumedPeak bilirubin (mg/dL)Disease patternRadiological findingsHistological findings
Kapp et al[11]25, MAbdominal pain, brown urine, jaundice, pruritusPowder, 1 to 2 teaspoon twice a day and increased to 4-6 teaspoon over 2 wk (1 teaspoon approximately 2-3 g)Direct bilirubin 29.3Cholestatic (increased bilirubin, AST, ALT, ALP)USG, CT-hepatic steatosisCholestatic injury, no hepatocellular damage, canalicular cholestasis
Drago et al[14]23, MJaundice, pale stool, brown urine for 4 dPowder, 85 g total over 6 wkDirect bilirubin 5.8Cholestatic (increased bilirubin, AST, ALT, ALP)USG, CT-normalCholestatic liver injury
Bernier et al[15]41, FJaundice, diarrhea, pruritusForm not available, 1 teaspoon twice daily for 1 wkDirect bilirubin 15Cholestatic (increased bilirubin, AST, ALT, ALP)-Intralobular bile duct destruction with cholestatic overload
Shah et al[16]30, FAbdominal pain, jaundice, dark urine, pruritusTea containing Kratom, dose not availableDirect bilirubin 18Cholestatic (increased bilirubin, AST, ALT, ALP)MRI-normal, ERCP–no bile duct obstructionIntrahepatic cholestasis
Riverso et al[13]38, MDark urine, light stools, feverNot availableTotal bilirubin 5.6Cholestatic (increased bilirubin, AST, ALT, ALP)USG-normalAcute cholestatic injury, mild bile duct injury, portal inflammation
Mackenzie et al[17] and De Francesco et al[18]27, MVomiting, epigastric pain, diarrhea with associated heavy alcohol intakePowder, 3-4 teaspoon multiple times weekly for several wkTotal bilirubin 11.2Cholestatic (increased bilirubin, AST, ALT, ALP)-Widespread hepatocellular necrosis with extracellular cholestasis
Fernandes et al[12]52, MMild fatigue, jaundiceCrushed leaves with water, 1 teaspoon (approximately 1.5 g) once or twice a day for 2 moTotal bilirubin 28.9Cholestatic (increased bilirubin, ALP; slightly increased AST, ALT)MRI - normalCanalicular cholestasis, bile duct injury, hepatic lobule injury, mixed inflammation in portal tracts
Aldyab et al[10]40, FAbdominal pain, feverForm not available, once a week for 1 moTotal bilirubin 5.1Mixed cholestatic and hepatocellular (increased bilirubin, AST, ALT, ALP)CT, MRCP–mild, nonspecific periportal edemaGranulomatous duct injury
Pronesti et al[19]30, MDark urine and pale stool for 1 wk, scleral icterus for 1 dPowder with water, for 4-6 wkTotal bilirubin 5.7, direct bilirubin 4.5Cholestatic (increased bilirubin, AST, ALT, ALP)USG–coarse hepatic echotextureHepatocellular and canalicular cholestasis with inflammation and focal prominent eosinophils. No fibrosis
LiverTox case 6972[20]25, MAbdominal pain, fever, jaundice, dark urine, pruritusPowder, for 23 dTotal bilirubin 22.4Mixed Hepatocellular and cholestatic (increased bilirubin, AST, ALT, ALP)USG, CT–gall bladder wall thickening with increased perihepatic lymph nodesCholestatic injury with mild necrosis and inflammation