Table 1.

Cases of kratom-induced liver injury with histologic evaluation

Report	Age	Sex	Kratom use	Other substance use	Presentation	LFTs at presentationa				Histology	Outcome
						Total bilirubin (mg/dL)	ALT (IU/L)	AST (IU/L)	ALP (IU/L)
Gandhi et al.	37	F	Yes	None	Nausea, decreased appetite, fatigue, jaundice, and pale stools	10.3	578	455	672	Zone 3 cholestasis, lymphocytic portal inflammation, and steatohepatitis	Improvement of symptoms and laboratory values at the 6-d follow-up.
Kapp et al.	25	M	Yes	None	Fever, chills, dark urine, abdominal pain, jaundice, and diffuse pruritis	30.9	94	66	173	Pure cholestasis	Total bilirubin 5.8 mg/dL at the 47-d follow-up.
Aldyab et al.	40	F	Yes	Nettle leaf supplements and oral contraceptive	Fever and acute abdominal pain,	5.1	875	462	162	Mixed portal inflammation, bile duct injury, granulomas, venous endotheliitis, and scattered ballooning hepatocytes	Resolution of symptoms and laboratory values at the 19-wk follow-up.
Riverso et el.	38	M	Yes	Acetaminophen	Fever, chills, dark urine, and pale stools	5.1	389	220	304	Mild mixed portal inflammation, mild bile duct injury, and mild zone 3 canalicular and hepatocellular cholestasis	Total bilirubin decrease to 1.6 mg/dL 8 d after cessation. ALT 410 and AST 142.
Fernandes et al.	52	M	Yes	Acetaminophen	Fatigue and scleral icterus	22.8	62	48	259	Marked canalicular cholestasis, mild mixed portal inflammation, mild bile duct injury, and mild lobular inflammation	Total bilirubin decrease to 4.0 mg/dL at the 4-wk follow-up.

^aLFTs, liver function tests; total bilirubin (0.0–1.6 mg/dL); ALT, alanine transaminase (<50 IU/L); AST, aspartate transaminase (<40 IU/L); ALP, alkaline phosphatase (40–130 IU/L).