Reversible Nyctalopia Associated With Vitamin a Deficiency After Resected Malignant Ileal Carcinoid and Pancreatic Adenocarcinoma

Abstract

Vitamin A deficiency-related retinopathy after abdominal surgery may be an underreported complication. This case provides a unique clinical perspective in our patient with a history of ileal carcinoid and Stage III pancreatic adenocarcinoma and confirms that rapid symptomatic and electroretinographic recovery is possible with appropriate treatment.

Disruption of the Outer Segments of the Photoreceptors on Optical Coherence Tomography as a Feature of Vitamin a Deficiency

“…Nevertheless, all patients displayed abnor-malities of the OS layer on OCT. Although a more prominent OS disruption with an accumulation of hyper-reflective material under the ellipsoid zone of the photoreceptors 5,6,9 has been noted in most of the previous case reports, the OCT features seen in our patients were subtler, consisting only of poorly distinguishable OS and an absent IZ; closest to the case published by de Carvalho et al 8 Interestingly, Hansen et al described a "normal OCT" of a patient with vitamin A deficiency and decreased ERG 4 ; however, on review, the IZ is not clearly recognizable in the published OCT figure. This highlights the subtlety of the vitamin A related OCT features and the need for improvement of their recognition.…”

“…Single reports of patients with vitamin A deficiency have described white dotted fundus, circular hypoautofluorescent dots on FAF, and hyperreflective material beneath the ellipsoid zone on OCT [4][5][6][7][8][9] ; however, neither of these features were consistently observed in a larger patient cohort making this case series the largest so far. Contrary to the previous reports, none of our patients exhibited white dotted fundus; moreover, hypoautofluorescent dots on FAF were noted in only one patient.…”

“…1 Prolonged malnutrition, malabsorption, or abnormal metabolism can result in vitamin A deficiency. Functional deficiencies in the form of nyctalopia and rod or rod-cone dysfunction have been well recognized in association with vitamin A deficiency [2][3][4] ; however, there are little data on the structural changes that occur in the retina. We describe optical coherence tomography (OCT) features of vitamin A deficiency observed in three patients.…”

Outer retina changes on optical coherence tomography in vitamin A deficiency

“…Vitamin A deficiency can lead to a well-known array of ocular complications, including nyctalopia, xerosis with Bitot spots, and xanthopsia [9, [21][22][23]. If detected early, oral or intramuscular vitamin A replacement can reverse ocular complications prior to permanent vision loss [16,24,25]. Only a few reports have described the photoreceptor changes on spectral domain optical coherence tomography (SD-OCT) [26][27][28].…”

The global leadership into malnutrition criteria reveals a high percentage of malnutrition which influences overall survival in patients with gastroenteropancreatic neuroendocrine tumours

“…Severe vitamin A deficiency could lead to night blindness and has been published in several case reports. [50][51][52][53] Vitamin D deficiency could lead to osteopenia or osteoporosis which has been reported in 1 study regarding 50 patients with small intestinal NETs and vitamin D deficiency, osteopenia was prevalent in 36%-44% of patients and osteoporosis in 24%-32% of patients. 16 Magnesium deficiency could result in several clinical symptoms or problems with other minerals such as potassium or calcium.…”