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Vitamin a deficiency and xerophthalmic fundus in autoimmune hepatitis and cirrhosis.
[hirschsprung disease]
To
report
a
patient
with
autoimmune
hepatitis
and
cirrhosis
who
was
diagnosed
with
severe
vitamin
A
deficiency
based
on
the
findings
of
xerophthalmic
fundus
.
Retrospective
chart
review
.
A
36
-
year
-old
African
American
woman
who
had
a
history
of
autoimmune
hepatitis
and
cirrhosis
presents
with
peripheral
retinal
white
spots
,
which
led
to
the
diagnosis
of
vitamin
A
deficiency
.
The
patient
presented
to
the
eye
clinic
for
intermittent
blurry
vision
3
months
after
the
diagnosis
of
liver
cirrhosis
secondary
to
autoimmune
hepatitis
since
age
15
.
She
also
underwent
partial
large
and
small
intestine
resection
as
an
infant
for
Hirschsprung
disease
.
Anterior
segment
examination
was
significant
for
severe
punctate
epithelial
erosions
and
posterior
segment
examination
was
significant
for
extensive
white
spots
in
the
peripheral
retina
in
both
eyes
.
Workup
showed
near
nondetectable
levels
of
vitamin
A
(
<
0
.
06
mg
/
L
,
normal
0
.
3
-
1
.
2
mg
/
L
)
and
retinyl
palmitate
(
<
0
.
02
mg
/
L
,
normal
>
0
.
2
mg
/
L
)
.
After
treatment
with
200
,
000
IU
of
vitamin
A
orally
,
the
white
spots
slowly
resolved
in
∼
6
months
.
She
never
developed
nyctalopia
and
her
dry
eye
symptoms
completely
resolved
.
Although
rare
,
vitamin
A
deficiency
should
be
considered
in
patients
with
liver
cirrhosis
especially
in
those
with
a
history
of
intestinal
surgeries
.
Early
diagnosis
and
treatment
with
vitamin
A
supplementation
can
reverse
the
signs
and
symptoms
of
xerophthalmia
.