title: To chew or not to chew: that's the question.
abstract: A 25-year-old Somalian man was referred to the department of internal medicine because of nausea, vomiting and jaundice of recent onset. On physical examination, he was frankly icteric without clinical signs of chronic liver disease. Laboratory data showed evidence of acute hepatitis. Viral serologic tests for hepatitis A, B, C and E were negative. Antinuclear antibodies (ANA) were positive (titre 1 : 1280; speckled pattern, NV < 1 : 40) as well anti-actin antibodies (titre 75 UA, NV < 20). A liver biopsy was performed and showed a feature compatible with toxic hepatitis. On further questioning, the patient admitted to daily chew Khat when he was living in Somalia. We concluded to Khat-induced toxic hepatitis together with high-titre anti-nuclear antibody mimicking serologic patterns of auto-immune hepatitis.
authors.affiliation: a Department of Internal Medicine , Saint Luc University Hospital , Brussels , Belgium.
authors.forename: Halil
authors.initials: H
authors.lastname: Yildiz
authors.affiliation: b Department of Anatomopathology , Saint Luc University Hospital , Brussels , Belgium.
authors.forename: Mina
authors.initials: M
authors.lastname: Komuta
authors.affiliation: c Hospital Regional Talca , Chili.
authors.forename: Constanza
authors.initials: C
authors.lastname: Monsalve
authors.affiliation: d Department of Gastroenterology , Saint Luc University Hospital , Brussels , Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Starkel
authors.affiliation: e Chantal Lefebvre Department of Internal Medicine , Saint Luc University Hospital , Brussels , Belgium.
authors.forename: Chantal
authors.initials: C
authors.lastname: Lefebvre
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear; D029754:Catha / Q000009:adverse effects*; D006505:Hepatitis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008297:Male; D008409:Mastication; D028321:Plant Preparations / Q000009:adverse effects*
chemical_list: D000974:Antibodies, Antinuclear; D028321:Plant Preparations
keywords: Autoimmune hepatitis; Catha edulis; Hepatitis; Herbal medicine; Kath