Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Case Report

Volume 12, Number 4, August 2019, pages 211-215

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

Figure 1. Representative microscopic images of the liver biopsy (H&E stain). (a) Marked interlobular bile duct injury with infiltrating lymphocytes within the ductal epithelium (× 200). (b) Vaguely formed granuloma encases a damaged bile duct (arrow) (× 309). (c) Endotheliitis with subendothelial lymphocytes (× 200). (d) Poorly formed lobular granulomas (arrows) (× 223).

**Table 1.** Liver Biochemistry
	ALT (IU/L)	AST (IU/L)	Bilirubin (mg/dL)	ALP (IU/L)
ALT: alanine aminotransferase; AST: aspartate aminotransferase; ALP: alkaline phosphatase.
Initial presentation	875	462	5.1	162
3 weeks	60	16	0.6	98
5 weeks	28	16	0.6	61
19 weeks	24	12	0.3	62
Reference range	5 - 60	5 - 45	0.1 - 1.2	30 - 115

Table 1. Liver Biochemistry

ALT (IU/L)

AST (IU/L)

Bilirubin (mg/dL)

ALP (IU/L)

ALT: alanine aminotransferase; AST: aspartate aminotransferase; ALP: alkaline phosphatase.

Initial presentation

875

462

5.1

162

3 weeks

0.6

5 weeks

0.6

19 weeks

0.3

Reference range

5 - 60

5 - 45

0.1 - 1.2

30 - 115

**Table 2.** Kratom-Induced Hepatotoxicity in the Literature
Age	Gender	Presentation	Kratom use	Abnormal LFT	Imaging	Liver biopsy	Reference
LFT: liver function test; ALT: alanine aminotransferase; AST: aspartate aminotransferase; r-GT: gamma-glutamyl transferase; ALP: alkaline phosphatase; N/A: not available; Ref: reference; sl: slight abnormality.
38	Male	Fever, chill, dark colored urine, light colored stool	Yes	ALT, AST, bilirubin, r-GT, ALP	Normal	Mild portal inflammation, mild duct injury, mild ductular proliferation, focal endotheliitis, cholestasis	[15]
25	Male	Fever, chill, dark colored urine, abdominal pain, jaundice, pruritis	Yes	ALT (sl), AST (sl), bilirubin, ALP (sl)	Normal	Bland cholestasis (histologic image not provided)	[16]
52	Male	Jaundice	Yes	ALT (sl), AST (sl), bilirubin, ALP	Normal	Canalicular cholestasis, mixed portal inflammation, duct injury, mild ductular proliferation, mild lobular injury (histologic image not provided)	[17]
70	Male	Jaundice, nausea, fatigue, weight loss	Yes	AST (sl), bilirubin, ALP	Normal	N/A	[8]
58	Male	Jaundice	Yes (repeat use)	ALT, AST, bilirubin, ALP, ammonia	Normal	N/A	[12]
47	Male	Dark colored urine, pruritis, fatigue	Yes (repeat use)	ALT, AST, bilirubin, ALP	Liver steatosis	N/A	[13]
31	Male	Fever, dark colored urine, malaise, fatigue	Yes	ALT, AST, bilirubin, ALP	N/A	N/A	[30]

Table 2. Kratom-Induced Hepatotoxicity in the Literature

Age

Gender

Presentation

Kratom use

Abnormal LFT

Imaging

Liver biopsy

Reference

LFT: liver function test; ALT: alanine aminotransferase; AST: aspartate aminotransferase; r-GT: gamma-glutamyl transferase; ALP: alkaline phosphatase; N/A: not available; Ref: reference; sl: slight abnormality.

Male

Fever, chill, dark colored urine, light colored stool

Yes

ALT, AST, bilirubin, r-GT, ALP

Normal

Mild portal inflammation, mild duct injury, mild ductular proliferation, focal endotheliitis, cholestasis

[15]

Male

Fever, chill, dark colored urine, abdominal pain, jaundice, pruritis

Yes

ALT (sl), AST (sl), bilirubin, ALP (sl)

Normal

Bland cholestasis (histologic image not provided)

[16]

Male

Jaundice

Yes

ALT (sl), AST (sl), bilirubin, ALP

Normal

Canalicular cholestasis, mixed portal inflammation, duct injury, mild ductular proliferation, mild lobular injury (histologic image not provided)

[17]

Male

Jaundice, nausea, fatigue, weight loss

Yes

AST (sl), bilirubin, ALP

Normal

N/A

[8]

Male

Jaundice

Yes (repeat use)

ALT, AST, bilirubin, ALP, ammonia

Normal

N/A

[12]

Male

Dark colored urine, pruritis, fatigue

Yes (repeat use)

ALT, AST, bilirubin, ALP

Liver steatosis

N/A

[13]

Male

Fever, dark colored urine, malaise, fatigue

Yes

ALT, AST, bilirubin, ALP

N/A

[30]