Night blindness and Crohn's disease.
Signs of malnutrition are common clinical features in Crohn's disease; and bowel resection, commonly needed in these cases, can aggravate malnutrition. These patients are at risk of developing vitamin A deficiency, which can lead to night blindness. We present a 60-year-old male, with history of Crohn's disease and multiple resections for strictures and fistulas leading to short bowel syndrome, with progressive bilateral loss of night vision (nyctalopia). Serum vitamin A level was markedly depleted (11 µg/dL, reference 20-120 µg/dL), and full-field electroretinogram testing demonstrated extinguished scotopic (rod function) responses and decreased amplitudes of photopic responses on 30 Hz flicker (cone function). He was started on vitamin A supplementation (initially intramuscular). His vitamin A level was back to normal (78 µg/dL), and night vision problems subjectively improved. Patients with Crohn's disease should be inquired about night vision problems. The presence of nyctalopia should prompt vitamin A level measurement and ophthalmology referral for further evaluation.
Cleveland Clinic Cole Eye Institute, 9500 Euclid Avenue i-32, Cleveland, OH, 44195, USA.
Breno
B
da Rocha Lima
Francesco
F
Pichi
Careen Y
CY
Lowder
D003424:Crohn Disease / Q000150:complications*; D019587:Dietary Supplements; D006801:Humans; D008297:Male; D008875:Middle Aged; D009755:Night Blindness / Q000209:etiology*; D016896:Treatment Outcome; D014801:Vitamin A / Q000627:therapeutic use; D014802:Vitamin A Deficiency / Q000150:complications*; D014815:Vitamins / Q000627:therapeutic use
D014815:Vitamins; D014801:Vitamin A