Our patient, a 25-year-old man, with a BMI of 23.4 kg/m2, ingested kratom for 2 weeks. He was aware of and curious about the effects of the drug and ordered the powdered substance via the Internet, where it was advertised as an additive for footbaths. He ordered two kinds of powder (so-called Thai Pimp and Malaysian Green, both powder from ground up leaves) and took both powders on a daily basis orally, washing the powder down with orange juice. The ingested amount started with one to two teaspoons (one teaspoon is about 2.3–3.5 g, corresponding to approximately five to eight dried leaves) twice daily. In the course of 2 weeks, he increased the intake to four to six teaspoons daily. No further illicit drugs, medication (e.g., antibiotics, analgesics), dietary supplements, or alcohols were consumed; the patient’s diet was adequate, and he was otherwise healthy. He described the effect of the drug as mildly relaxing, causing tiredness, and noticed a loss of appetite, without observing any stimulating effects. After cessation of drug intake due to inconvenient swallowing, he developed subjective fever and chills on day 2 after cessation, which lasted for about 1 week. On day 5 after cessation, he noticed slight abdominal discomfort, which developed into intense abdominal pain on day 8 and concomitant brown discoloration of the urine. The next day, the patient developed noticeable jaundice and pruritus and consulted his physician. He was admitted to hospital on that same day, approximately 10 days after cessation. The initial physical examination showed a pronounced jaundice but was otherwise unremarkable
