Possible green tea-induced thrombotic thrombocytopenic purpura.
OBJECTIVE
A case of a patient who developed thrombotic thrombocytopenic purpura (TTP) after consuming a weight-loss product containing green tea is reported.


CONCLUSIONS
A 38-year-old, 68-kg Caucasian woman arrived at the emergency department with a one-week history of malaise, fatigue, and petechiae of the skin. She had no symptoms of infection and denied illegal drug use. Her medical history included hypothyroidism, for which she was treated with levothyroxine 150 microg daily for the past four years. She reported that she had been using a green tea preparation for the two months before admission to lose body weight. The daily preparation contained 200 mg of green tea extract 5:1, equivalent to 1 g of natural green tea. On clinical examination, the patient appeared acutely ill and was afebrile, with pallor, petechiae, and purpura of the extremities. Laboratory test results at the time of admission revealed that the patient had anemia and marked thrombocytopenia. A peripheral blood smear demonstrated a feature of microangiopathic hemolytic anemia. Immunoglobulin G autoantibodies against ADAM metallopeptidase with thrombospondin type 1 motif, 13 were detected. On hospital day 3, the patient appeared confused and exhibited aphasia that was initially transient but then recurrent. Brain computerized tomography did not exhibit focal pathology. Over the next few days, her neurologic symptoms subsided and her platelet count and hematocrit value gradually increased. Plasmapheresis was performed (12 procedures). Corticosteroid treatment was also initiated. After 20 days of hospitalization, the patient was discharged.


CONCLUSIONS
A 38-year-old woman developed TTP after consuming a weight-loss product containing green tea extract for two months.
Department of Internal Medicine, Hippokration General Hospital of Athens, Athens, Greece. geoliat@in.gr
George D
GD
Liatsos
Antonios
A
Moulakakis
Ioannis
I
Ketikoglou
Stella
S
Klonari
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D005260:Female; D006400:Hematocrit; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000188:drug therapy; D010956:Plasmapheresis; D011693:Purpura / Q000209:etiology / Q000473:pathology; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced* / Q000473:pathology; D013662:Tea / Q000009:adverse effects*; D013974:Thyroxine / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D015431:Weight Loss
D000305:Adrenal Cortex Hormones; D013662:Tea; D013974:Thyroxine