Hepatic Injury from Chronic Hypervitaminosis a Resulting in Portal Hypertension and Ascites

TLDR

Chronic hypervitaminosis A can cause liver damage that obstructs hepatic blood flow, leading to portal hypertension and ascites. Histologic and ultrastructural analysis revealed perisinusoidal fibrosis, central‑vein sclerosis, lipid‑laden Ito cells, and markedly elevated hepatic vitamin A, indicating that chronic vitamin A ingestion induces fibrogenesis and cirrhosis‑like liver injury. N Engl J Med 291:435–440, 1974.

Abstract

Chronic hypervitaminosis A was diagnosed in two patients who were initially seen because of ascites and clinical signs of cirrhosis. Histologic examination of liver-biopsy material revealed perisinusoidal fibrosis, central-vein sclerosis and focal congestion associated with perisinusoidal lipid-storage cells. Vitamin A fluorescence was found on frozen sections, and direct assay of tissue revealed substantial increases in vitamin A content (1700 to 2200 μg per gram of wet liver). Electron microscopy demonstrated an increase in basement-membrane-like material and collagen within the perisinusoidal space in association with lipid-filled Ito cells. The nature of this unusual lesion suggested that it might obstruct hepatic blood flow, result in considerable parenchymal-cell atrophy and lead to portal hypertension. These findings suggest that chronic ingestion of large amounts of vitamin A stimulates fibrogenesis and results in a disorder of hepatic function resembling cirrhosis. (N Engl J Med 291:435–440, 1974)