Khat-associated Autoimmune Hepatitis: A Review with RUCAM Analysis.

Area of Science:

• Hepatology
• Toxicology
• Pharmacology

Background:

• Khat (Catha edulis) is a stimulant plant widely used in East Africa and the Arabian Peninsula.
• Its psychoactive compounds, cathinone and pyrrolizidine alkaloids, possess sympathomimetic properties.
• Emerging evidence suggests a link between khat consumption and autoimmune hepatitis (AIH).

Purpose of the Study:

• To provide an updated review of acute and chronic forms of khat-associated AIH.
• To explore cathinone metabolism, pharmacokinetics, and proposed mechanisms of khat-induced hepatotoxicity.
• To synthesize published cases and aid in clinical management guidance.

Main Methods:

• Literature review synthesizing published cases of khat-associated AIH.
• Analysis of causality using the Roussel-Uclaf Causality Assessment Method (RCAM).
• Application of the simplified Hennes AIH score where data permitted.

Main Results:

• Khat-associated AIH presents with elevated autoimmune markers and characteristic liver biopsy findings.
• Clinical improvement is observed upon khat cessation or with corticosteroid treatment.
• Recurrence is typically absent after successful management.

Conclusions:

• Khat use is a potential trigger for autoimmune hepatitis.
• Prompt diagnosis and management involving cessation and/or corticosteroids are crucial.
• This review aids clinicians in recognizing and managing this specific form of drug-induced liver injury.