title: Vitamin A toxicity: when one a day doesn't keep the doctor away.
abstract: Vitamin A toxicity has been reported to cause severe liver disease and, occasionally, liver failure. Herein we present the case of a 60-year-old male with symptoms of muscle soreness, alopecia, nail dystrophy, and ascites. He continued to deteriorate with the development of refractory ascites, renal insufficiency, encephalopathy, and failure to thrive. A liver biopsy demonstrated presence of Ito cells and vacuolated Kupffer cells without the presence of cirrhosis. His clinical history revealed ingestion of large doses of vitamin A. His worsening clinical situation ruled out the possibility of a transjugular intrahepatic portosystemic shunt. The patient underwent orthotopic liver transplantation with resolution of symptoms. Vitamin A toxicity should be considered in the differential diagnosis of noncirrhotic portal hypertension. In conclusion, liver transplantation is a valid option if no improvement occurs in spite of cessation of the medication.
authors.affiliation: Division of Transplantation Medicine, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
authors.forename: Rekha
authors.initials: R
authors.lastname: Cheruvattath
authors.forename: Mauricio
authors.initials: M
authors.lastname: Orrego
authors.forename: Manjushree
authors.initials: M
authors.lastname: Gautam
authors.forename: Thomas
authors.initials: T
authors.lastname: Byrne
authors.forename: Shayan
authors.initials: S
authors.lastname: Alam
authors.forename: Marina
authors.initials: M
authors.lastname: Voltchenok
authors.forename: Mark
authors.initials: M
authors.lastname: Edwin
authors.forename: James
authors.initials: J
authors.lastname: Wilkens
authors.forename: James W
authors.initials: JW
authors.lastname: Williams
authors.forename: Hugo E
authors.initials: HE
authors.lastname: Vargas
mesh_terms: D056486:Chemical and Drug Induced Liver Injury; D003937:Diagnosis, Differential; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis; D006986:Hypervitaminosis A / Q000150:complications* / Q000473:pathology; D008099:Liver / Q000187:drug effects / Q000473:pathology / Q000601:surgery*; D008107:Liver Diseases / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D014801:Vitamin A / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D014801:Vitamin A