Acute Hepatitis Caused by Green Tea Infusion: A Case Report

Arzenton E

doi:10.4172/2167-1052.1000170

Abstract

The green tea is obtained by an unfermented process of leaves of Camellia sinensis and the main chemical components are polyphenols, particularly epigallocatechin-3-gallate and epicatechin-3-gallate that could be associated to adverse hepatic reactions. We present a case of acute hepatitis caused by the use of green tea.A 62-year-old woman was hospitalized because of the persistent high levels of liver function tests. After the hospitalization a lot of instrumental exams and blood checks were performed. The search of metallic elements in the used green tea infusions was performed using an inductively coupled-plasma mass spectrometry; high performance liquid chromatography-electro spray ionization-mass spectrometry analysis was done to characterize the metabolite profiles of the infusions of green tea. The blood check showed in particular alanine aminotransferase (780 U/L) and total bilirubin (1.15 mg/dL) levels abnormal. The abdominal echography and other blood parameters were normal, but liver biopsy described a “drug toxic damage”. Every day over the previous 9 months the patient drank two or three cups of several brands of green tea infusions and she stopped this behavior when abdominal pain was persistent. Her medical history didn’t report the use of other drugs or toxic products. After four months of stopping the use of green tea infusions, the liver function tests were normalized. The presence of metallic elements in tea infusion cannot justify the observed liver toxicity in our patient. Instead, the highest levels of epigallo catechin methyl gallate derived from epigallocatechin-3-gallate observed in one of the samples consumed by the patient, arise a possible correlation between some of the catechins in green tea and the hepatotoxic effect. It is conceivable that the mechanism of damage can be idiosyncratic-metabolic or allergic.

Highlights

The consumption of tea originated in China and Southeast Asia thousands of years ago and was thereafter introduced progressively all around the world
We present a case of a hepatic damage in a patient that consumed daily green tea infusion, we reported the results of analysis of polyphenols and metallic elements in the used products
Green tea infusions have been prepared from four batches of green tea used by the patient plus other additional 3 batches purchased from the local market, pouring 50 ml of hot water (80°C) on 0.5 mg of tea leaves; after 5 minutes the infusions were centrifuged for 10 min at 16,000g at 4°C and filtered through 0.2 μm pore filters

Summary

Introduction

The consumption of tea originated in China and Southeast Asia thousands of years ago and was thereafter introduced progressively all around the world. After a month from admission at First Aid, she was hospitalized because of the persistent high levels of liver function tests During the hospitalization these exams were performed: abdominal echography was negative, serum ALT 365 U/L, AST 178 U/L (reference range 6-44 U/L), ALP 113 U/L, GGT 109 U/L, total bilirubin 1.41 mg/dL, ferritin 939 μg/L, serum iron 218 μg/dL, and non organ-specific autoantibodies (ANA, ENA, ASMA, AMA, LKM) were negative. After four months of stopping the use of green tea infusions, the liver function tests were normalized and ferritin was reduced: ALT 26 U/L, AST 28 U/L, ALP 84 U/L, GGT 26 U/L, total bilirubin 0.68 mg/ dL, ferritin 324 μg/L, serum iron 161 μg/dL (Figure 1 for ALT trend). After the hospitalization the presence of metallic elements and catechins in the different brands of green tea consumed by the patient was performed using appropriated techniques

Methods and Results of Metallic Elements Analysis

Detection and Results of Catechin Analysis

Discussion

Conclusion