Hypervitaminosis A Inducing Intra-hepatic Cholestasis—A Rare Case Report

• Published in: Experimental and molecular pathology Vol. 88; no. 2; pp. 324 - 325
• Main Authors: Ramanathan, Vivek S., Hensley, Gary, French, Samuel, Eysselein, Victor, Chung, David, Reicher, Sonya, Pham, Binh
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.04.2010; Elsevier
• Subjects: Biological and medical sciences; Cholestasis; Cholestasis, Intrahepatic - chemically induced; Cholestasis, Intrahepatic - etiology; Cholestasis, Intrahepatic - pathology; Ephedra - toxicity; Gastroenterology. Liver. Pancreas. Abdomen; Herbalife; Humans; Hypervitaminosis A - complications; Hypervitaminosis A - pathology; Investigative techniques, diagnostic techniques (general aspects); Jaundice - chemically induced; Jaundice - etiology; Jaundice - pathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Pruritus - chemically induced; Pruritus - etiology; Pruritus - pathology; Toxicity; Vacuoles - pathology; Vacuoles - ultrastructure; Vitamin A; Vitamin A - toxicity; Vitamins; Herbalife; Vitamin A; Toxicity; Cholestasis; Digestive system; Liver; Nutrition disorder; Vitamin; Biliary tract disease; Retinol; Case study; Hypervitaminosis; Anatomic pathology; Cholostasis; Digestive diseases; Nutritional status
• ISSN: 0014-4800; 1096-0945
• DOI: 10.1016/j.yexmp.2009.11.007

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 HerbalifeTM 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.