Chewing of leaves from the Catha edulis (khat) plant has amphetamine-like, stimulating effects and is used in rituals among East African men. In recent years, a possible liver-toxic effect has been observed in Somali immigrants in Western countries and has in severe cases led to death or liver transplantation. It is discussed whether the liver insufficiency represents a severe ethnic variant of autoimmune hepatitis, or a khat-induced hepatitis with autoimmune features. We describe six patients with Somalian background and possibly khat-induced toxic hepatitis.