慢性維他命A過多症

Chronic Hypervitaminosis A

錢光新(k. S. Tsien) ； 許守道(S. T. Hsu) ； 陳烱霖(C. L. Chen)

《Acta Paediatrica Sinica》 10卷4期 (1969/12) Pp. 164-175

摘要

著者於本文中報告1例慢性維他命A過多症，病兒為一個6歲8月之男孩，於1969年3月22日住院。住院原因乃因於住院前約一個半月內，以下各症狀絡續出現：皮膚發癢，嘴唇乾燥破裂，口角炎、鼻出血、小腿痛、腳背痛，輕度發熱及前臂痛。身體檢查時可見到兩邊前臂，小腿中部及兩脚背部發痛，脚背外半邊紅腫及主要在双臂外面，兩小腿前面及背部有皮膚乾燥，脫皮現並有很多抓痕及去色素之白色小斑。
病孩曾於住院前約一年半時期內，每天口服含有約100,000u. 維他命A之魚肝油。
骨骼之X光檢查發現兩邊尺骨，脛骨及第2、3、4、5蹠骨等骨幹有骨外層質骨織增生現象。血清維他命A濃度升至219μg%。
住院後卽停服魚肝油。各臨床症狀亦很快消失或減經。於住院10天後出院時病孩僅尚有輕度小腿痛，脚背痛，皮膚抓痕及不少去色素小白斑。
於出院後3月再檢查時臨床症狀全已消失，僅留下皮膚去色素小白斑。X光片上之骨外層質骨識增生現象有很大進步，但骨外層質仍較正常為厚。血清維他命A濃度己降至正常。
著者並根據綜閱之文獻，分析並討論此病之臨床症狀，檢驗結果，病情過程，致病原因，診斷，治療及預防等問題。

並列摘要

A case of chronic hypervitaminosis A is reported. The boy, aged 6 y. 8 m., was admitted to our pediatric ward on March 22, 1969, because during the 1½ month period prior to the admission, the boy successively suffered from skin itching, dryness and fissure of lips, angulostomatitis, pain of legs, back of feet, mild fever and pain of forearms. Physical examination showed tenderness at both forearms, middle part of legs, back of feet, reddish swelling of the external half of back of feet, dryness, mild desquamation, scratching lesions and whitish depigmented spots chiefly at the external face of both arms, anterior face of both legs and the back.
The boy had received fish liver oil containing about 100,000 u. of vitamin A daily for about 1.5 year.
Radiographic examination of the bones showed cortical hyperostosis of the diaphysis of both ulnas, tibias, 2nd, 3rd, 4th and 5th metatarsal bones. Serum vitamin A level was elevated to 219 μg.%.
The administration of fish liver oil was stopped after admission, the clinical manifestations improved rapidly. At discharge 10 days after admission, the boy had only mild pain of legs and feet scratching lesions and numerous small depigmented spots. The follow up examination of the boy 3 months after discharge showed that all clinical manifestations had disappeared except the persistence of depigmented spots. Radiographic examination showed that cortical hyperostosis had much improved. Serum vitamin A level had returned to normal range.
The literature was reviewed, and clinical manifestations, laboratory results, course, pathogenesis, diagnosis, treatment and prevention of the disease were discussed.