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

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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)