Hepatotoxicity from green tea: a review of the literature and two unpublished cases.
OBJECTIVE
To review the current literature on suspected green tea-related hepatic reactions and to describe two new cases reported within the framework of the Italian surveillance system of natural health products.


RESULTS
A literature search of publication between 1999 and October 2008 retrieved 34 cases of hepatitis. Histological examination of the liver revealed inflammatory reactions, cholestasis, occasional steatosis, and necrosis. A positive dechallenge was reported in 29 cases. There was one reported death. A positive rechallenge occurred in seven cases (20%). In the two new cases, the causality assessment was judged as "possible" according to the RUCAM score.


CONCLUSIONS
Our analysis of the published case reports suggests a causal association between green tea and liver damage. The hepatotoxicity is probably due to (-)-epigallocatechin gallate or its metabolites which, under particular conditions related to the patient's metabolism, can induce oxidative stress in the liver. In a few cases, toxicity related to concomitant medications could also be involved.
Mazzanti
Gabriela
G
Department of Physiology and Pharmacology, Sapienza, University of Rome, Rome, Italy. gabriela.mazzanti@uniroma1.it
Menniti-Ippolito
Francesca
F
Moro
Paola Angela
PA
Cassetti
Federica
F
Raschetti
Roberto
R
Santuccio
Carmela
C
Mastrangelo
Sabina
S
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000009:adverse effects; D002392:Catechin / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications / Q000188:drug therapy / Q000201:enzymology / Q000209:etiology* / Q000378:metabolism; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D007558:Italy; D007565:Jaundice / Q000209:etiology; D008099:Liver / Q000187:drug effects* / Q000201:enzymology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D016877:Oxidants / Q000009:adverse effects*; D018384:Oxidative Stress; D013662:Tea / Q000009:adverse effects*; D055815:Young Adult
D000975:Antioxidants; D016877:Oxidants; D013662:Tea; D002392:Catechin