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Kava Herb-Induced Liver Injury as Verified by the Updated RUCAM.

Sahan Withanage1,2, Carl Cosgrave1,2, Shoa Zafir3

  • 1University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia, barwonhealth.org.au.

Case Reports in Gastrointestinal Medicine
|January 1, 2026
PubMed
Summary
This summary is machine-generated.

Kava consumption can cause acute liver injury, marked by elevated liver enzymes (ALT and AST). Clinicians should consider kava as a potential cause of herb-induced liver injury (HILI) in patients with unexplained transaminitis.

Keywords:
drug-induced liver injuryhepatotoxicitykavaliver

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Area of Science:

  • Hepatology
  • Toxicology
  • Herbal Medicine Research

Background:

  • Herb-induced liver injury (HILI) is an emerging concern with increasing use of herbal remedies.
  • Kava, a traditional Pacific Island drink, has been anecdotally linked to liver damage.
  • Prompt identification of HILI causes is crucial for patient management.

Purpose of the Study:

  • To report a case of acute liver injury temporally associated with kava consumption.
  • To highlight the potential of kava as a cause of herb-induced liver injury.
  • To increase clinician awareness of kava-induced hepatotoxicity.

Main Methods:

  • A case study of a 46-year-old male presenting with fatigue and jaundice.
  • Assessment of liver function tests (ALT, AST) and imaging studies.
  • Liver biopsy to evaluate hepatocellular damage.
  • Updated Roussel Uclaf Causality Assessment Method (RUCAM) score calculation.

Main Results:

  • The patient exhibited significant elevation in ALT (1546 U/L) and AST (920 U/L) after kava use.
  • Liver biopsy showed hepatocellular necrosis and ballooning degeneration.
  • An updated RUCAM score of 7 indicated a probable kava-induced liver injury.
  • Liver enzymes normalized after kava cessation without further intervention.

Conclusions:

  • Kava consumption can lead to acute liver injury, presenting as significant transaminitis.
  • Kava should be considered in the differential diagnosis of unexplained liver enzyme elevation, especially in patients with relevant exposure.
  • Further research into the pathogenesis of kava-induced liver injury is warranted due to its increasing popularity.