Bilateral hippocampal toxicity in a patient using kratom

As an emerging toxic recreational drug, kratom use has been associated with a range of adverse effects, but reports of structural changes in the central nervous system are rare. We report a case of a young man in his 20s with a history of anxiety and depression who presented with an altered mental status and anterograde and retrograde amnesia following kratom use. His labs showed elevated alanine aminotransferase and ammonia levels, and his MRI revealed bilateral hippocampal T2 hyperintensity signal changes. Following cessation of kratom and supportive care, the patient improved. This case highlights the importance of considering kratom as a potential cause of neurological symptoms in patients presenting with an altered mental status due to toxic ingestion.