Retinol
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Intrahepatic cholestasis: case report A 46-year-old man developed intrahepatic cholestasis during intake of retinol [vitamin A] as a dietary supplement. The man had been taking a Herbalife shake and two Herbalife multivitamins daily (equivalent to retinol 5082 IU/day) for 12 years when he developed an enlarged liver, jaundice, pruritus and excoriations. He had undergone removal of a biliary stent (for a common bile duct stricture) 15 days previously. ALP was 193 U/L, AST was 44 U/L, ALT was 68 U/L and total bilirubin was 11.2 mg/dL. Three days later, a biliary stent was placed for an 8mm distal common bile duct stricture. Levels of total bilirubin and ALP continued to increase (20.3 mg/dL and 288 U/L, respectively). Endoscopic retrograde cholangiopancreatography revealed that bile flow was good, with no intrahepatic duct dilatation. However, pathology showed prominent centrilobular cholestasis, with intracellular cytoplasmic necrosis in Kupffer cells and thrombi in dilated intrahepatic bile ducts. The findings were consistent with vitamin A toxicity. The use of Herbalife was discontinued. Two months later, jaundice had resolved completely and liver function tests were normal. Three months later, no stricture was evident on removal of the biliary stent. Eight months after stent removal, laboratory tests remained normal. Ramanathan VS, et al. Hypervitaminosis A inducing intra-hepatic cholestasis - a rare case report. Experimental and Molecular Pathology 88: 324-325, No. 2, Apr 2010. Available from: URL: http://dx.doi.org/10.1016/j.yexmp.2009.11.007 803014304 USA
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Reactions 22 May 2010 No. 1302
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