Fulminant hepatic failure following overdose of the vitamin A metabolite acitretin

Hepatotoxicity associated with the therapeutic ingestion of the vitamin A metabolite acitretin is well recognized. No reported cases of hepatic dysfunction as a consequence of acitretin overdose are, however, present. Here for the first time we report a case of fulminant hepatic failure following an intentional overdose of 600 mg of acitretin. The patient fulfilled the King's College Hospital poor prognostic criteria by 66 h after overdose, but demonstrated a rapid improvement thereafter and did not require liver transplantation. Given the known association between psoriasis and depression, and the possible association of acitretin with psychiatric illness, this is an important potential adverse event.