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Effective than Kratom powders. There are fewer than 5 reported circumstances in the literature from North America detailing kratom-induced liver harm and just one with specific hepatic histologic findings. Bone marrow damage. Liver histology seen in Figures 1 and 2 from our patient is per hepatocellular and canalicular cholestasis with portal areas exhibiting focally prominent eosinophils. A liver biopsy was carried out with the histology seen in Figures 1 and 2. It revealed inflammation with hepatocellular and canalicular cholestasis without fibrosis suggesting kratom-induced liver injury. Vitals were unremarkable. Labs revealed alkaline phosphatase 556, AST 125, ALT 308, total bilirubin 5.7, and direct bilirubin 4.5. Computed tomography (CT) of the abdomen and pelvis was conducted and was unremarkable. Liver ultrasound revealed a coarsened liver echotexture. A chronic liver disease panel including hepatitis A, B, and C, iron studies, ceruloplasmin, alpha-1 antitrypsin stage, mitochondrial antibody, and liver-kidney microsomal antibody have been adverse with the exception of a ferritin 405 and an anti-easy muscle antibody 1:20 titer.

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