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Case Reports
. 2022 Apr 7;9(4):e00715.
doi: 10.14309/crj.0000000000000715. eCollection 2022 Apr.

Kratom (Mitragyna speciosa)-Induced Hepatitis

Devin R Allison  1 , Muhammad Mubarak  2 , Neal Sharma  2 , Deepthi S Rao  1
Affiliations
Case Reports

Kratom (Mitragyna speciosa)-Induced Hepatitis

Devin R Allison et al. ACG Case Rep J. .

Abstract

Kratom is a plant with opioid-like properties known to produce stimulant and analgesic effects. Although there are numerous studies on the psychoactive components of kratom, less is known about the toxicity. Specifically, few reports describe kratom-induced hepatotoxicity and demonstrate histological features. We provide a case report detailing the clinicopathologic findings of drug-induced liver injury caused by kratom. The laboratory workup included significant elevation of total bilirubin and alkaline phosphatase. Liver biopsy demonstrated a prominent canalicular cholestatic pattern, mixed portal inflammation, and newly described perivenular necrosis. This report provides additional information on kratom toxicity because its use continues to rise.

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Figures

Figure 1.
Figure 1.
(A and B) Canalicular cholestasis in which yellow-brown chunks of concentrated bile (arrows) are present in hepatic canaliculi (hematoxylin and eosin stain, 400× magnification). (C) The bracketed area shows perivenular (acinar zone 3) necrosis which appears pale compared with the adjacent parenchyma because of the loss of hepatocytes (hematoxylin and eosin stain, 100× magnification). (D) The portal areas show minimal interface hepatitis with a mixed inflammatory infiltrate, mostly consisting of lymphocytes, but scattered neutrophils (arrows) and eosinophils are present (hematoxylin and eosin stain, 400× magnification). (E) A Periodic acid-Schiff (PAS) stain with diastase shows intact basement membranes of original bile ducts (arrows) and the associated vascular structures within the portal areas (PAS, 400× magnification). (F) A lack of periportal and perivenular fibroses, which would stain type 1 collagen bright blue if present (trichrome stain, 100× magnification). There is minimal canalicular fibrosis throughout the specimen.
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