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Acute Hepatitis in a Yemeni Immigrant Associated with Khat: A “Biological Amphetamine” Carried in Cultures

Viral infections, alcohol, hepatic steatosis, autoimmunity medications and herbal supplements are common etiologies of hepatitis. Khat (Catha Edulis) is a commonly used recreational substance in East African and Middle Eastern countries. Khat has been reported in the literature to be associated with...

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Autores principales: Patel, Harish, Kumar, Kishore, Essrani, Rajesh Kumar, Niazi, Masooma, Makker, Jasbir, Nayudu, Suresh Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006146/
https://www.ncbi.nlm.nih.gov/pubmed/33800126
http://dx.doi.org/10.3390/clinpract11010023
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author Patel, Harish
Kumar, Kishore
Essrani, Rajesh Kumar
Niazi, Masooma
Makker, Jasbir
Nayudu, Suresh Kumar
author_facet Patel, Harish
Kumar, Kishore
Essrani, Rajesh Kumar
Niazi, Masooma
Makker, Jasbir
Nayudu, Suresh Kumar
author_sort Patel, Harish
collection PubMed
description Viral infections, alcohol, hepatic steatosis, autoimmunity medications and herbal supplements are common etiologies of hepatitis. Khat (Catha Edulis) is a commonly used recreational substance in East African and Middle Eastern countries. Khat has been reported in the literature to be associated with hepatotoxicity, which can present in several forms, including chronic liver disease. The possible pathogenesis of liver injury could be secondary to biochemical components of Khat itself or additives such as pesticides or preservatives. An autoimmune mechanism of liver injury has also been postulated, supported by sparse evidence. We present a case of a Yemeni immigrant with acute hepatitis whose fear about social norms and breaching confidentiality made it challenging to identify Khat as being the underlying cause. A 34-year-old man from Yemen presented with right upper quadrant pain of one day duration. He had predominantly elevated transaminases with mild elevation in bilirubin. His investigations were negative for the viral, metabolic or biliary etiology. A persistent focus on clinical history and the well-established physician–patient relationship revealed a history of Khat use. The liver biopsy finding of lobular hepatitis was compatible with drug-induced liver injury and established the finding of Khat hepatotoxicity. Subsequently, the patient improved with conservative management.
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spelling pubmed-80061462021-03-30 Acute Hepatitis in a Yemeni Immigrant Associated with Khat: A “Biological Amphetamine” Carried in Cultures Patel, Harish Kumar, Kishore Essrani, Rajesh Kumar Niazi, Masooma Makker, Jasbir Nayudu, Suresh Kumar Clin Pract Case Report Viral infections, alcohol, hepatic steatosis, autoimmunity medications and herbal supplements are common etiologies of hepatitis. Khat (Catha Edulis) is a commonly used recreational substance in East African and Middle Eastern countries. Khat has been reported in the literature to be associated with hepatotoxicity, which can present in several forms, including chronic liver disease. The possible pathogenesis of liver injury could be secondary to biochemical components of Khat itself or additives such as pesticides or preservatives. An autoimmune mechanism of liver injury has also been postulated, supported by sparse evidence. We present a case of a Yemeni immigrant with acute hepatitis whose fear about social norms and breaching confidentiality made it challenging to identify Khat as being the underlying cause. A 34-year-old man from Yemen presented with right upper quadrant pain of one day duration. He had predominantly elevated transaminases with mild elevation in bilirubin. His investigations were negative for the viral, metabolic or biliary etiology. A persistent focus on clinical history and the well-established physician–patient relationship revealed a history of Khat use. The liver biopsy finding of lobular hepatitis was compatible with drug-induced liver injury and established the finding of Khat hepatotoxicity. Subsequently, the patient improved with conservative management. MDPI 2021-03-08 /pmc/articles/PMC8006146/ /pubmed/33800126 http://dx.doi.org/10.3390/clinpract11010023 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Patel, Harish
Kumar, Kishore
Essrani, Rajesh Kumar
Niazi, Masooma
Makker, Jasbir
Nayudu, Suresh Kumar
Acute Hepatitis in a Yemeni Immigrant Associated with Khat: A “Biological Amphetamine” Carried in Cultures
title Acute Hepatitis in a Yemeni Immigrant Associated with Khat: A “Biological Amphetamine” Carried in Cultures
title_full Acute Hepatitis in a Yemeni Immigrant Associated with Khat: A “Biological Amphetamine” Carried in Cultures
title_fullStr Acute Hepatitis in a Yemeni Immigrant Associated with Khat: A “Biological Amphetamine” Carried in Cultures
title_full_unstemmed Acute Hepatitis in a Yemeni Immigrant Associated with Khat: A “Biological Amphetamine” Carried in Cultures
title_short Acute Hepatitis in a Yemeni Immigrant Associated with Khat: A “Biological Amphetamine” Carried in Cultures
title_sort acute hepatitis in a yemeni immigrant associated with khat: a “biological amphetamine” carried in cultures
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006146/
https://www.ncbi.nlm.nih.gov/pubmed/33800126
http://dx.doi.org/10.3390/clinpract11010023
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