Green tea extract–associated acute liver injury: Case report and review

Tea consumption is an aspect of many cultures worldwide. Green tea, particularly made from the leaves of Camellia sinensis (L.), is part of daily tea rituals in the East. In addition to cultural considerations, green tea enjoys great popularity worldwide because of its potential preventive health effects. Green tea contains a number of phytochemicals, which can be subdivided into three groups of substances: terpenes, alkaloids, and phenols. The medically most relevant group within the phenols are the flavanoids, of which the catechins account for up to 20% of the dry matter. The catechins consist of catechin (C), epicatechin (EC), gallocatechin, epigallocatechin (EGC), and epigallocatechin gallate (EGCG), of which the EGCG is the pharmacologically most active polyphenol.1 Although the enjoyment of green tea as an undisputed health remedy is highly popular, more than 200 cases of liver failure, sometimes even requiring liver transplantation, associated with green tea have been published within the last 30 years. Although traditional green tea preparation rarely instigates major medical problems, extreme use of concentrated green tea extract (GTE), such as in mixed preparations taken in powder or tablet form for weight loss, have more frequently been described.2,3