[A systemic-like disease: chronic vitamin A poisoning]

Area of Science:

• Toxicology
• Nutritional Science
• Hepatology

Background:

• Vitamin A is essential for vision, immune function, and cell growth.
• Chronic excessive intake (hypervitaminosis A) can lead to toxic effects.
• Understanding the clinical manifestations and pathological changes of vitamin A toxicity is crucial.

Observation:

• A young man presented with diffuse arthralgia, weight loss, fever, skin and hair changes, hepatomegaly, ascites, and pleural effusion.
• Laboratory findings included elevated ESR, hypercalcemia, and acute renal failure.
• Despite normal plasma vitamin A and retinol-binding-protein levels, tissue analysis revealed very high hepatic vitamin A concentrations.

Findings:

• Withdrawal of vitamin A led to symptom resolution, except for persistent liver enlargement.
• Iliac bone biopsy demonstrated cortical thickening and increased bone resorption.
• Liver biopsy revealed swollen Ito cells obliterating the space of Disse, with subsequent fibrosis development.

Implications:

• This case underscores the potential for severe toxicity from chronic, high-dose vitamin A ingestion, even with normal circulating levels.
• Hepatic Ito cell changes and subsequent fibrosis represent a significant pathological consequence of vitamin A overload.
• Monitoring and awareness of vitamin A toxicity are essential in clinical practice.