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Acute Hepatitis After Green Tea Ingestion

GENTIANA BAKAJ, MD, and KARLENE HEWAN-LOWE, MD
East Carolina University

Volume 52 - Issue 5 - May 2012

A 33-year-old woman with a history of hypothyroidism presented to the hospital with nausea, vomiting, diarrhea, and abdominal pain of 1 month’s duration. She was found to be jaundiced, and the results of liver function tests (LFTs) were abnormal. For 3 months, the patient had been taking a green tea dietary supplement for weight loss and had stopped using the product 1 month before presentation. She denied the use of alcohol or acetaminophen or any other over-the-counter medication.

Figure: The hepatic lobule shows inflammatory changes. Hepatocytes (H) are adjacent to sinusoids (S) that have swollen Kupffer cells and inflammatory cells. Portal tracts show bile ductular proliferation and a mixed inflammatory infiltrate (I). Eosinophils (arrows) are present. (Hematoxylin-eosin. Original magnification X400.)

 

On physical examination, she appeared jaundiced, and she had mild right upper quadrant pain. She was afebrile, and her white blood cell count was normal. Her initial LFT results were aspartate aminotransferase (AST), 1338 U/L; alanine aminotransferase (ALT), 1216 U/L; total bilirubin (TB), 11.1 mg/dL; direct bilirubin (DB), 8.5 mg/dL; and alkaline phosphatase (AP), 154 U/L.

Workup for other causes of hepatitis was negative: hepatitis A, B, and C; HIV; anti-smooth muscle; antimitochondrial; and antinuclear antibody. Alpha 1-antitrypsin and ceruloplasmin levels were normal. IgG was mildly elevated at 1567 mg/dL.

Magnetic resonance cholangiopancreatography revealed diffuse gallbladder wall thickening without biliary ductal dilatation, intraductal filling defect, or focal stricture. Ultrasonography showed moderate diffuse gallbladder wall thickening, no shadowing gallstones, a negative sonographic Murphy’s sign, and no biliary ductal dilatation.

Liver biopsy revealed marked inflammatory infiltration in both portal and lobular regions, including lymphocytes, eosinophils, and plasma cells (Figure). Iron staining was negative.

During her hospital stay, the patient became asymptomatic and her transaminase levels started to trend downward. She was discharged home.

At a follow-up appointment 3 days later, her LFT results had increased: AST, 1713 U/L; ALT, 1377 U/L; TB, 18.7 mg/dL; and AP, 140 U/L. International normalized ratio was 1.5, and prothrombin time was 14.1 seconds. The next day the patient was scheduled to be evaluated at another facility for possible liver transplant.

Discussion. Various beneficial health effects have been claimed for nutritional additives based on green tea. In multiple studies, green tea has to date been considered useful for its potential hepatic protective properties.However, several case reports on hepatotoxicity after the intake of green tea derivatives have been published. Analysis of these reports suggests a causal association between green tea and liver damage. A concern should be raised about the safety of green tea. It is very important to take a thorough history, with attention to over-the-counter drugs and herbal products.

FOR MORE INFORMATION:

  • Bergman J, Schjøtt J. Hepatitis caused by Lotus-f3? Basic Clin Pharmacol Toxicol. 2009;104(5):414-416.
  • Gloro R, Hourmand-Ollivier I, Mosquet B, et al. Fulminant hepatitis during self-medication with hydroalcoholic extract of green tea. Eur J Gastroenterol Hepatol. 2005;17(10):1135-1137.
  • Mazzanti G, Menniti-Ippolito F, Moro PA, et al. Hepatotoxicity from green tea: a review of the literature and two unpublished cases. Eur J Clin Pharmacol. 2009;65(4):331-341.
  • Vanstraelen S, Rahier J, Geubel AP. Jaundice as a misadventure of a green tea (camellia sinensis) lover: a case report. Acta Gastroenterol Belg. 2008; 71(4):409-412.
  • Verhelst X, Burvenich P, Van Sassenbroeck D, et al. Acute hepatitis after treatment for hair loss with oral green tea extracts (Camellia sinensis). Acta Gastroenterol Belg. 2009;72(2):262-264.