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Histologic Characterization of Kratom Use-Associated Liver Injury

Kratom is an herbal product derived from the leaves of Southeast Asian Mitragyna speciosa trees. It has traditionally been used by indigenous people to relieve fatigue and manage pain, diarrhea, or opioid withdrawal. The use of kratom has become more commonplace in the United States for similar purp...

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Autores principales: Riverso, Michael, Chang, Michael, Soldevila-Pico, Consuelo, Lai, Jinping, Liu, Xiuli
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elmer Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827910/
https://www.ncbi.nlm.nih.gov/pubmed/29511414
http://dx.doi.org/10.14740/gr990e
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author Riverso, Michael
Chang, Michael
Soldevila-Pico, Consuelo
Lai, Jinping
Liu, Xiuli
author_facet Riverso, Michael
Chang, Michael
Soldevila-Pico, Consuelo
Lai, Jinping
Liu, Xiuli
author_sort Riverso, Michael
collection PubMed
description Kratom is an herbal product derived from the leaves of Southeast Asian Mitragyna speciosa trees. It has traditionally been used by indigenous people to relieve fatigue and manage pain, diarrhea, or opioid withdrawal. The use of kratom has become more commonplace in the United States for similar purposes. Only rare reports of kratom liver toxicity exist in the literature but without histologic characterization. Herein, we report one case of kratom use-associated liver toxicity in a 38-year-old patient. The patient complained of dark colored urine and light colored stools after using kratom. He had unremarkable physical examination. Laboratory testing at presentation revealed elevated alanine aminotransferase (389 U/L), aspartate aminotransferase (220 U/L), total bilirubin (5.1 mg/dL), and alkaline phosphatase (304 U/L). There was no serology evidence of viral hepatitis A, B, and C. The acetaminophen level at presentation was below detectable limits. Ultrasound examination of the right upper quadrant revealed normal echogenicity and contour of the liver without bile ductal dilatation or disease of the gallbladder. The patient underwent liver biopsy 4 days after the initial presentation which revealed a pattern of acute cholestatic liver injury including zone 3 hepatocellular and canalicular cholestasis, focal hepatocyte dropout, mild portal inflammation, and bile duct injury. Kratom was stopped, the patient improved clinically and biochemically and was discharged 8 days after the initial presentation. To our best knowledge, this is the first case report detailing the histology of kratom use-associated liver injury.
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spelling pubmed-58279102018-03-06 Histologic Characterization of Kratom Use-Associated Liver Injury Riverso, Michael Chang, Michael Soldevila-Pico, Consuelo Lai, Jinping Liu, Xiuli Gastroenterology Res Case Report Kratom is an herbal product derived from the leaves of Southeast Asian Mitragyna speciosa trees. It has traditionally been used by indigenous people to relieve fatigue and manage pain, diarrhea, or opioid withdrawal. The use of kratom has become more commonplace in the United States for similar purposes. Only rare reports of kratom liver toxicity exist in the literature but without histologic characterization. Herein, we report one case of kratom use-associated liver toxicity in a 38-year-old patient. The patient complained of dark colored urine and light colored stools after using kratom. He had unremarkable physical examination. Laboratory testing at presentation revealed elevated alanine aminotransferase (389 U/L), aspartate aminotransferase (220 U/L), total bilirubin (5.1 mg/dL), and alkaline phosphatase (304 U/L). There was no serology evidence of viral hepatitis A, B, and C. The acetaminophen level at presentation was below detectable limits. Ultrasound examination of the right upper quadrant revealed normal echogenicity and contour of the liver without bile ductal dilatation or disease of the gallbladder. The patient underwent liver biopsy 4 days after the initial presentation which revealed a pattern of acute cholestatic liver injury including zone 3 hepatocellular and canalicular cholestasis, focal hepatocyte dropout, mild portal inflammation, and bile duct injury. Kratom was stopped, the patient improved clinically and biochemically and was discharged 8 days after the initial presentation. To our best knowledge, this is the first case report detailing the histology of kratom use-associated liver injury. Elmer Press 2018-02 2018-02-23 /pmc/articles/PMC5827910/ /pubmed/29511414 http://dx.doi.org/10.14740/gr990e Text en Copyright 2018, Riverso et al. http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Riverso, Michael
Chang, Michael
Soldevila-Pico, Consuelo
Lai, Jinping
Liu, Xiuli
Histologic Characterization of Kratom Use-Associated Liver Injury
title Histologic Characterization of Kratom Use-Associated Liver Injury
title_full Histologic Characterization of Kratom Use-Associated Liver Injury
title_fullStr Histologic Characterization of Kratom Use-Associated Liver Injury
title_full_unstemmed Histologic Characterization of Kratom Use-Associated Liver Injury
title_short Histologic Characterization of Kratom Use-Associated Liver Injury
title_sort histologic characterization of kratom use-associated liver injury
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827910/
https://www.ncbi.nlm.nih.gov/pubmed/29511414
http://dx.doi.org/10.14740/gr990e
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