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

A 22-year-old man, had ingested more than 300 10(6) I.U. of vitamin A over a 2-year period. He presented with diffuse arthralgia, weight loss, low-grade fever, dryness and peeling of the skin, hair loss, liver enlargement with ascites and pleural effusion. He had a raised E.S.R., hypercalcemia and acute renal failure. Plasma levels of vitamin A and retinol-binding-protein were in the normal range. All symptoms disappeared after withdrawal of vitamin A except for the liver enlargement. Iliac bone biopsy showed cortical thickening, numerous resorptive lacunae and no index of bone formation. Liver biopsy showed obliteration of the space of Disse by swollen fat-storing cells (Ito cells). Tissue levels of vitamin A were very high in the liver. A second biopsy, 6 months later, showed a decrease of fat storage in the Ito cells but the development of a fibrosis.