Herbert L. Bonkovsky, MD
Potential Financial Conflicts of Interest: None disclosed.
Bonkovsky HL. Hepatotoxicity Associated with Supplements Containing Chinese Green Tea (Camellia sinensis). Ann Intern Med. 2006;144:68-71. doi: 10.7326/0003-4819-144-1-200601030-00020
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Published: Ann Intern Med. 2006;144(1):68-71.
TO THE EDITOR:
Background: Recent reports have identified an association between hepatotoxicity and health supplements containing green tea extract (Camellia sinensis).
Objective: To present a new case study involving a patient who exhibited a positive response to a rechallenge and to summarize previous reports of C. sinensis-associated hepatotoxicity.
Methods and Findings: A 37-year-old Hispanic woman was evaluated for a 10-day history of diffuse abdominal pain, nausea, and jaundice. She had been using a weight-loss supplement called The Right Approach Complex (Pharmanex, Provo, Utah) for 4 months. She was afebrile. Her serum aspartate aminotransferase (AST) level was 1783 U/L (reference range, 17 to 39 U/L), her serum alanine aminotransferase (ALT) level was 1788 U/L (reference range, 8 to 39 U/L), her serum total bilirubin level was 200 µmol/L (11.7 mg/dL) (reference range, 7 to 24 µmol/L [0.4 to 1.4 mg/dL]), her serum direct bilirubin level was 169 µmol/L (9.9 mg/dL) (reference range, 0 to 3 µmol/L [0 to 0.2 mg/dL]), her serum alkaline phosphatase level was 238 U/L (reference range, 39 to 113 U/L), and her serum albumin level was 650 µmol/L (reference range, 580 to 800 µmol/L). Results of serologic tests for antibodies against hepatitis A IgM, hepatitis C, and hepatitis B surface antigen were negative. An antinuclear antibody titer was weakly positive (1:40, speckled); results of tests for antiliver-kidney microsomal, anti-dsDNA, anti-smooth muscle, and antimitochondrial antibodies were negative. Liver biopsy revealed marked interface necrosis and inflammation and mild lobular inflammation. Cholecystectomy and intraoperative cholangiography were performed; the gallbladder and bile ducts were normal, and there was no evidence of cholecystitis or stones. The patient was discharged on day 13. One month later, her serum AST level was 79 U/L, her serum ALT level was 92 U/L, and her serum total bilirubin level was 33 µmol/L (1.9 mg/dL).
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