Article: Bilateral corneal ulceration caused by vitamin a deficiency in eosinophilic gastroenteropathy

Purpose: Vitamin A deficiency is a very rare condition in the developed world and can lead to a variety of ocular changes from xerosis and xerophthalmia to corneal ulcer and perforation. The treatment of this devastating disease is simple and inexpensive. It is therefore important to recognize and treat accordingly, especially in the event of ulcers unresponsive to treatment or in the presence of severe malnutrition/malabsorption syndromes. The purpose of this case report is to remind physicians of the potentially devastating effects of vitamin A deficiency on the eyes and to demonstrate outcomes after vitamin A treatment.

Methods: Single observational case report.

Results: A 29-year-old male with known eosinophilic gastroenteropathy was treated with oral steroids for peripheral ulcerative keratitis. Two weeks after resolution, the patient suffered from peripheral ulcerative keratitis in his other eye, with a self-sealing perforation. Vitamin A deficiency was confirmed and successfully treated, leading to subsequent resolution of signs and symptoms.

Conclusions: Vitamin A deficiency can be present in patients with malabsorption and malnutrition syndromes and should be considered as cause of corneal ulceration.

Citing Articles

Keratomalacia and corneal perforation in vitamin A deficiency: Anterior-segment optical-coherence-tomography and histological findings.

Weller J, Tourtas T, Kruse F Am J Ophthalmol Case Rep. 2024; 36:102169.

PMID: 39314248 PMC: 11417524. DOI: 10.1016/j.ajoc.2024.102169.

Vitamin A Deficiency Screening in Patients With Chronic Alcohol-Associated Liver Disease: Implications for Liver Transplant Candidates.

Choudhry H, Zhu A, Choudhry H, Pyrsopoulos N, Dastjerdi M ACG Case Rep J. 2023; 10(7):e01099.

PMID: 37441625 PMC: 10335819. DOI: 10.14309/crj.0000000000001099.

Xerophthalmia: Findings from the Eye Lead to Diagnosis of a Fatal Intestinal Disease.

Tulu Aygun B, Kepez Yildiz B, Ogutmen Koc D, Yildirim Y Beyoglu Eye J. 2022; 5(2):149-152.

PMID: 35098080 PMC: 8784477. DOI: 10.14744/bej.2020.93063.

Corneal perforation due to vitamin A deficiency in a patient with short bowel syndrome.

Fieldhouse H, Nestel A, Theron B, Knox Cartwright N BMJ Case Rep. 2021; 14(9).

PMID: 34511420 PMC: 8438734. DOI: 10.1136/bcr-2021-242776.

Bilateral liquefactive corneal necrosis: a rare and devastating complication of vitamin A deficiency in the adult.

Lata S, Bafna R, Asif M, Sachan A BMJ Case Rep. 2021; 14(2).

PMID: 33608333 PMC: 7896612. DOI: 10.1136/bcr-2020-237343.

References

1.

Rogers E, Douglass W, Russell R, Bushman L, HUBBARD T, Iber F . Deficiency of fat soluble vitamins after jejunoileal bypass surgery for morbid obesity. Am J Clin Nutr. 1980; 33(6):1208-14. DOI: 10.1093/ajcn/33.6.1208. View

2.

Bishara S, Merin S, Cooper M, Azizi E, Delpre G, Deckelbaum R . Combined vitamin A and E therapy prevents retinal electrophysiological deterioration in abetalipoproteinaemia. Br J Ophthalmol. 1982; 66(12):767-70. PMC: 1039925. DOI: 10.1136/bjo.66.12.767. View

3.

Sommer A, Tarwotjo I . Protein deficiency and treatment of xerophthalmia. Arch Ophthalmol. 1982; 100(5):785-7. DOI: 10.1001/archopht.1982.01030030789012. View

4.

Thylefors B, Negrel A, Pararajasegaram R, Dadzie K . Global data on blindness. Bull World Health Organ. 1995; 73(1):115-21. PMC: 2486591. View

5.

Berthout A, Sellam M, Denimal F, Lalau J, Milazzo S . [The eye and anorexia nervosa. A case report]. J Fr Ophtalmol. 2007; 30(6):e15. DOI: 10.1016/s0181-5512(07)89670-7. View

6.

Brooks Jr H, Driebe Jr W, Schemmer G . Xerophthalmia and cystic fibrosis. Arch Ophthalmol. 1990; 108(3):354-7. DOI: 10.1001/archopht.1990.01070050052029. View

7.

Russell R, Morrison S, Smith F, Oaks E, Carney E . Vitamin-A reversal of abnormal dark adaptation in cirrhosis. Study of effects on the plasma retinol transport system. Ann Intern Med. 1978; 88(5):622-6. DOI: 10.7326/0003-4819-88-5-622. View

8.

Smith J, Steinemann T . Vitamin A deficiency and the eye. Int Ophthalmol Clin. 2000; 40(4):83-91. DOI: 10.1097/00004397-200010000-00007. View

9.

Baig M, Qadir A, Rasheed J . A review of eosinophilic gastroenteritis. J Natl Med Assoc. 2006; 98(10):1616-9. PMC: 2569760. View

10.

Benitez Cruz S, Candela C, Ruiz Martin M, Cos Blanco A . [Bilateral corneal ulceration as a result of caloric-protein malnutrition and vitamin A deficit in a patient with chronic alcoholism, chronic pancreatitis and cholecystostomy]. Nutr Hosp. 2005; 20(4):308-10. View

11.

Lucendo A . Eosinophilic diseases of the gastrointestinal tract. Scand J Gastroenterol. 2010; 45(9):1013-21. DOI: 10.3109/00365521003690251. View

12.

Eckert M, Perry J, Sohn V, Boden J, Martin M, Rush R . Incidence of low vitamin A levels and ocular symptoms after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010; 6(6):653-7. DOI: 10.1016/j.soard.2010.02.044. View

Bilateral Corneal Ulceration Caused by Vitamin a Deficiency in Eosinophilic Gastroenteropathy