A Probable Case of Kava Induced Cholestatic Liver Injury with Causality Assessment by the updated RUCAM

Abstract

Kava's safety profile continues to be debated as previous case reports have not performed adequate causality assessments or have only demonstrated possible causality. Furthermore, the pathogenicity of kava induced liver injury remains poorly understood. We describe here a case of cholestatic liver injury in a 48-year-old male with a two-month history of kava ingestion who presented with jaundice. After adjusting medications and stopping kava, the patient’s liver enzymes trended down. Using the Roussel Uclaf Causality Assessment Method (RUCAM), which is the most up-to-date diagnostic causality algorithm for herb and drug induced liver injury, kava was determined to be the probable cause of the patient’s liver injury along with possible causality from comedication. As comedication is a common feature among kava-induced liver injury, the pathogenicity may involve metabolic interactions between kavalactones and other exogenous substrates. Based on these findings, providers should continue warning patients of potentially fatal liver injury associated with kava use, especially with comedication, until quality control standards can ensure its safety. Keywords: Herb induced liver injury, kava, RUCAM, causality assessment, dietary supplements. Read more →