The Bitter Aftertaste of Kratom: A Toxicologic and Neurologic Challenge

Kratom (Mitragyna speciosa) is an increasingly used botanical substance with opioid-like properties. Products containing 7-hydroxymitragynine (7-OH), a potent μ-opioid receptor agonist, have been associated with severe toxicity, though clinical data remain limited. We report the case of a woman with polysubstance use disorder who presented following intentional ingestion of a large quantity of 7-OH. She developed profound central nervous system depression, marked QTc prolongation, and prolonged encephalopathy requiring intensive care admission and airway protection. Her hospital course was complicated by persistent neuropsychiatric symptoms, prompting extensive neurologic and psychiatric evaluation, including electroencephalography and cerebrospinal fluid analysis. Findings were consistent with a multifactorial encephalopathy related to toxic exposure, withdrawal, and underlying psychiatric illness, with possible infectious contribution. She improved with supportive care, cardiac monitoring, antimicrobial therapy, and psychiatric intervention, and was ultimately transferred to inpatient psychiatric care and substance-use rehabilitation. This case highlights the potential for severe and prolonged neurocardiac and neuropsychiatric toxicity following 7-OH ingestion and underscores the importance of clinical awareness of kratom-related complications, particularly in patients with polysubstance use and psychiatric comorbidities.