title: Khat (Catha Edulis) as a possible cause of autoimmune hepatitis.
abstract: OBJECTIVE
  To investigate the potential role of khat in triggering auto immune hepatitis.
  
  
  METHODS
  Patients with a history of khat use and acute hepatitis were identified using the computer database in the hepatology department at the Royal Hallamshire Hospital. They were then assessed for probability of having autoimmune hepatitis using the revised autoimmune hepatitis scoring criteria.
  
  
  RESULTS
  Six patients were identified. All of them had presented with acute hepatitis on a background of khat. All were male and five of these patients were of Somali origin, while one patient was from Yemen. The patients were given points on the modified autoimmune hepatitis score which is based on their liver enzymes, autoimmune screen, exclusion of viral hepatitis alcohol and drugs, immunoglobulin levels and liver histology. The patients were given a score of -4 for khat use due to its potential to cause drug induced liver injury. Five of these patients scored between 10 and 15 points, placing them in the probable group for having autoimmune hepatitis. All of these patients were treated with prednisolone and demonstrated a good response to immunosuppression.
  
  
  CONCLUSIONS
  One possibile cause of hepatotoxicity with khat could be via triggering of autoimmune hepatitis in a genetically susceptible individual. Further studies are needed for confirmation.
authors.affiliation: Shahzad Riyaz, Mohammad Imran, Dermot Gleeson, Mohammed A Karajeh, Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, S10 2JF, United Kingdom.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Riyaz
authors.affiliation: Shahzad Riyaz, Mohammad Imran, Dermot Gleeson, Mohammed A Karajeh, Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, S10 2JF, United Kingdom.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Imran
authors.affiliation: Shahzad Riyaz, Mohammad Imran, Dermot Gleeson, Mohammed A Karajeh, Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, S10 2JF, United Kingdom.
authors.forename: Dermot
authors.initials: D
authors.lastname: Gleeson
authors.affiliation: Shahzad Riyaz, Mohammad Imran, Dermot Gleeson, Mohammed A Karajeh, Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, S10 2JF, United Kingdom.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Karajeh
keywords: Acute hepatitis; Autoimmune hepatitis; Drug induced liver injury; Herbs; Khat