Hypervitaminosis A inducing intra-hepatic cholestasis--a rare case report.
The use of over-the-counter supplements is commonplace in today's health conscious society. We present an unusual case of intrahepatic cholestasis caused by vitamin A intoxication. The patient consumed one Herbalife shake with two multivitamin tablets of the same brand for 12 years. When calculated this equated to more than the recommended daily allowance for vitamin A consumption. Deranged liver function tests were consistent with a cholestatic process. Liver biopsy was obtained and revealed features pathognomonic of vitamin A toxicity, without the usual fibrosis. When the supplements were ceased, his jaundice and alkaline phosphatase completely normalized. This case highlights the importance of health care providers documenting non-prescribed dietary supplements and considering them in the etiology of cholestatic liver disease.
Ramanathan
Vivek S
VS
Department of Internal Medicine, St Mary Medical Center, Long Beach, CA, USA. drvivekram@gmail.com
Hensley
Gary
G
French
Samuel
S
Eysselein
Victor
V
Chung
David
D
Reicher
Sonya
S
Pham
Binh
B
D002780:Cholestasis, Intrahepatic / Q000139:chemically induced / Q000209:etiology* / Q000473:pathology; D029789:Ephedra / Q000633:toxicity; D006801:Humans; D006986:Hypervitaminosis A / Q000150:complications* / Q000473:pathology; D007565:Jaundice / Q000139:chemically induced / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011537:Pruritus / Q000139:chemically induced / Q000209:etiology / Q000473:pathology; D014617:Vacuoles / Q000473:pathology / Q000648:ultrastructure; D014801:Vitamin A / Q000633:toxicity*; D014815:Vitamins
C087890:Herbalife; D014815:Vitamins; D014801:Vitamin A