Hepatotoxicity Associated with Supplements Containing Chinese Green Tea (Camellia sinensis)

TO THE EDITOR:

Background: Recent reports have identified an association between hepatotoxicity and health supplements containing green tea extract (Camellia sinensis).

Objective: To present a new case study involving a patient who exhibited a positive response to a rechallenge and to summarize previous reports of C. sinensis-associated hepatotoxicity.

Methods and Findings: A 37-year-old Hispanic woman was evaluated for a 10-day history of diffuse abdominal pain, nausea, and jaundice. She had been using a weight-loss supplement called The Right Approach Complex (Pharmanex, Provo, Utah) for 4 months. She was afebrile. Her serum aspartate aminotransferase (AST) level was 1783 U/L (reference range, 17 to 39 U/L), her serum alanine aminotransferase (ALT) level was 1788 U/L (reference range, 8 to 39 U/L), her serum total bilirubin level was 200 µmol/L (11.7 mg/dL) (reference range, 7 to 24 µmol/L [0.4 to 1.4 mg/dL]), her serum direct bilirubin level was 169 µmol/L (9.9 mg/dL) (reference range, 0 to 3 µmol/L [0 to 0.2 mg/dL]), her serum alkaline phosphatase level was 238 U/L (reference range, 39 to 113 U/L), …