A 15-year-old girl presents to the emergency department complaining of headaches. The patient denies fever, sore throat, vomiting, and head trauma. Physical exam reveals facial acne, papilledema, and splenomegaly. Excess of which of the following vitamins is most likely causing her symptoms?

Vitamin A
Vitamin B3
Vitamin B6
Vitamin C
Vitamin E

Vitamin A.

Explanation:

Vitamin A excess can cause acute papilledema, characterized by blurred disc edges, an absent physiologic cup, and intraretinal exudates. It can also cause anorexia, slow growth, drying and cracking skin, enlargement of liver and spleen, bone fragility, swelling and pain of long bones, increased intracranial pressure, alopecia, and carotenemia. Vitamin A (retinol) is a fat-soluble vitamin and component of retinal pigments for vision in dim light. It is also involved in bone and tooth development and formation and maturation of epithelia. Vitamin A can be found in liver, fish, liver oils, whole milk, carotenoids, green vegetables, yellow fruits and vegetables. Vitamin A can be converted to retinoic acid (tretinoin) and isotretinoin, which are used in the treatment of acne and keratosis pilaris.