title: Concentrated green tea extract induces severe acute hepatitis in a 63-year-old woman--a case report with pharmaceutical analysis.
abstract: ETNOPHARMACOLOGICAL RELEVANCE: The popularity of concentrated green tea extracts as dietary supplements for a wide range of applications is increasing due to their health-promoting effects attributed to the high amounts of catechins they contain. The most important of the green tea catechins is (-)-epigallocatechin-3-O-gallate (EGCG). While their beneficiary effects have been studied extensively, a small number of adverse events have been reported in the medical literature. Here we present a typical reversible course of severe hepatitis after green tea consumption.
  
  
  METHODS
  The case study describes in a 63-year old woman during treatment with green tea-capsules upon recommendation of a cancer support group.
  
  
  RESULTS
  The histological finding was consistent with drug induced hepatitis, and other possible causes of hepatitis were excluded. According to the CIOMS/RUCAM score the causality was assessed as "probable". After discontinuation of medication, followed by extracorporal albumin dialysis, rapid and sustained recovery occurred. Pharmaceutically analysis (HPLC) of the green tea capsules did not give evidence for contaminants but revealed the two typical compounds of green tea, namely (-)-epigallocatechin-3-O-gallate (EGCG, 93.2%) and epicatechin (EC, 6.8%) at a very high dose level.
  
  
  CONCLUSIONS
  The present case highlights the fact that such concentrated herbal extracts from green tea may not be free of adverse effects under certain circumstances. There is still a lack of a uniform European Union-wide surveillance system for adverse drug reactions of herbal products. Therefore this case underlines the importance of public awareness in the potential risks in use of herbal products.
authors.affiliation: Department of Transplantation Medicine, University Hospital of Münster, Münster, Germany.
authors.forename: Mike H
authors.initials: MH
authors.lastname: Pillukat
authors.affiliation: Department of Transplantation Medicine, University Hospital of Münster, Münster, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Bester
authors.affiliation: Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Münster, Germany. Electronic address: ahensel@uni-muenster.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hensel
authors.affiliation: Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Münster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lechtenberg
authors.affiliation: Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Münster, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Petereit
authors.affiliation: Department of Transplantation Medicine, University Hospital of Münster, Münster, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.affiliation: Department of Pathology, University Hospital of Münster, Münster, Germany.
authors.forename: Klaus-Michael
authors.initials: KM
authors.lastname: Müller
authors.affiliation: Department of Transplantation Medicine, University Hospital of Münster, Münster, Germany.
authors.forename: Hartmut H J
authors.initials: HH
authors.lastname: Schmidt
mesh_terms: D000208:Acute Disease; D028241:Camellia sinensis / Q000737:chemistry; D002392:Catechin / Q000031:analogs & derivatives / Q000302:isolation & purification; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000503:physiopathology; D002851:Chromatography, High Pressure Liquid; D019587:Dietary Supplements / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010936:Plant Extracts / Q000009:adverse effects* / Q000737:chemistry; D012720:Severity of Illness Index; D013662:Tea
chemical_list: D010936:Plant Extracts; D013662:Tea; D002392:Catechin; C045651:epigallocatechin gallate
keywords: (−)-epigallocatechin-3-O-gallate (EGCG) (PubChem CID: 65064); Acute hepatitis; Albumin dialysis; Camellia sinensis (L.); Green tea