Reversible khat-induced hepatitis: two case reports and review of the literature

Abstract

Recreational chewing of Catha edulis (khat) leaves is part of the ethnic culture of Somali, Yemeni and other East African societies for its stimulant properties. With increasing emigration, khat use has become common in these ethnic groups once they move to other areas such as Europe and the USA; one-third of the UK Somali population report khat use within the last month. Cathinone, the active component of the khat leaves, is controlled under the UK Misuse of Drugs Act, but the use of the khat plant and its leaves remains not subject to control in the UK. There have been several previous reports of acute hepatitis related to chronic use of khat leading to acute liver failure, and resulting in transplantation or death. We report two cases with severe acute khat-related hepatitis that resolved on cessation of khat use initially, but relapsed with further use, reinforcing the importance of permanent khat cessation to prevent progression to liver failure. With reference to the current literature, we also consider the difficult diagnosis of this disorder, then go on to consider the pathophysiology, mechanisms of liver injury and potential future areas of research. BACKGROUNDRecreational chewing of Catha edulis (khat) leaves is part of the ethnic culture of Somali, Yemeni and other East African societies for its stimulant properties.

Acute Liver Injury Associated with Khat Use in a 24-Year-Old Male

“…The mechanism of khat-associated hepatotoxicity is not well elucidated, though animal studies demonstrate fibrosis and liver injury with chronic use [4]. The injury is typically hepatocellular causing raised transaminase enzymes and has in some cases induced an autoimmune hepatitis wherein autoantibodies develop [5]. Resolution of the hepatitis typically occurs with cessation of use; however, there are some reports of patients developing severe acute hepatitis resulting in death or requiring liver transplantation [4, 6].…”

“…Resolution of the hepatitis typically occurs with cessation of use; however, there are some reports of patients developing severe acute hepatitis resulting in death or requiring liver transplantation [4, 6]. Several other case reports have been published, implicating khat use in acute hepatitis cases in Somalian immigrants [5, 7, 8]. Patients typically presented after years of use, but some cases presented after chewing for only a few weeks.…”

Khat Intertwined Liver Damage

“…The histopathological study of their liver tissues revealed marked lobular hepatitis with no fibrosis in case 1, wherein case 2, fibrosis was evident. Both patients improved on khat cessation [12].…”

Tea in the Morning and Khat Afternoon: Health Threats Due to Khat Chewing

“…All protests began after the restarting of khat chewing. He was again advised to abstain from khat, and his LFTs improved gradually over eight weeks, returning to normal in six months [ 29 ].…”

“…He re-presented five months later with another acute hepatitis following an episode of khat chewing. High liver enzymes were noted and adverse viral profile; a liver magnetic resonance imaging (MRI) was done, which showed further reduction in the size of the left lobe of the liver with new fibrosis in the right lobe [ 29 ]…”