Vitamin A deficiency in a newborn resulting from maternal hypovitaminosis A after biliopancreatic diversion for the treatment of morbid obesity

Abstract Objectives Introduction: Biliopancreatic diversion (BPD) is a surgical procedure that causes weight loss via volume restriction and malabsorption. It is now rarely performed due to the risk of severe nutritional deficiencies including Vitamin A (1). Methods Case Description: A 68-year-old female status-post BPD in 1987 was referred for vitamin A deficiency. She initially had diminished night vision that progressed to left eye blindness by the time of her diagnosis in 2013. She was treated with oral vitamin A 100,000 IU daily; however, levels did not normalize, and her retinopathy progressed. She was later treated with intramuscular vitamin A and developed injection site rashes (Figure 1) thought to be due to an injection site reaction versus type IV hypersensitivity. Over time her vitamin A levels improved but her vision did not. Results Vitamin A deficiency is a preventable complication of BPD and can lead to permanent vision loss. A study of 376 BPD patients found that 1 year after surgery vitamin A levels were low in 52% and 4 years this increased to 69% despite supplementation compliance (2). Vitamin A injection site rashes have been reported in one case series of 3 patients (3), and skin testing revealed sensitivity to polysorbate 80. This is an emulsifier found in injectable vitamin A palmitate, other parental medications and some vaccines (3). Conclusions Vitamin screening is important in post-bariatric surgery patients. Rash following intramuscular vitamin A is uncommon and should be closely monitored for progressive allergic reaction and potential for reactions to other medications that contain similar components. Funding Sources None. Supporting Tables, Images and/or Graphs

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Diagnosis of suspected hypovitaminosis A using magnetic resonance imaging in African lions (Panthera leo)

Journal of the South African Veterinary Association ◽

10.4102/jsava.v76i3.414 ◽

2005 ◽

Vol 76 (3) ◽

Cited By ~ 8

Author(s):

M.P. Hartley ◽

R.M. Kirberger ◽

M. Haagenson ◽

L. Sweers

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Vitamin A ◽

Vitamin A Deficiency ◽

Clinical Signs ◽

Maximum Diameter ◽

Resonance Imaging ◽

Non Invasive ◽

Brain Measurements ◽

Hypovitaminosis A

Vitamin A deficiency is described in captive lions. Ante mortem diagnosis can either be made by serum analysis or liver biopsy, both of which may be problematic. This study utilised magnetic resonance imaging to identify vitamin A deficiency in lions with relatively mild clinical signs, which could otherwise be attributed to numerous other neurological conditions. Magnetic resonance imaging is a non-invasive, reliable diagnostic tool to demonstrate pathology typically associated with this condition. To accommodate varying lion ages and sizes, a number of cranium and brain measurements were compared with that of the maximum diameter of the occular vitreous humor. Occular ratios of the tentorium cerebelli osseum and occipital bone were most reliable in diagnosing the thickened osseous structures characteristic of hypovitaminosis A. The ratio of maximum : minimum dorsoventral diameter of the C1 spinal cord was also of value.

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Symptomatic Vitamin A Deficiency following Biliopancreatic Diversion

Obesity Surgery ◽

10.1381/096089203322190916 ◽

2003 ◽

Vol 13 (4) ◽

pp. 655-657 ◽

Cited By ~ 57

Author(s):

Michael Hatizifotis ◽

Kevin Dolan ◽

Leanne Newbury ◽

George Fielding

Keyword(s):

Vitamin A ◽

Biliopancreatic Diversion ◽

Vitamin A Deficiency

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Radiographic analysis of the thickness of the cranial bones in captive compared to wild-living cheetahs and in cheetahs with hypovitaminosis A

PLoS ONE ◽

10.1371/journal.pone.0255924 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255924

Author(s):

Martin J. Schmidt ◽

Gerhard Steenkamp ◽

Peter Caldwell ◽

Klaus Failing ◽

Robert M. Kirberger

Keyword(s):

Vitamin A ◽

Health Management ◽

Vitamin A Deficiency ◽

Serum Levels ◽

Bone Thickness ◽

Calvarial Bone ◽

Presumptive Diagnosis ◽

Vitamin A Status ◽

Skull Radiographs ◽

Hypovitaminosis A

Captive cheetahs often demonstrate a high incidence of diseases in which vitamin A imbalances are implicated. These can occur even under controlled and optimised feeding regimens, which is why surveillance of vitamin A status is mandatory in the successful health management of cheetahs. Serum levels of the vitamin do not reflect the true vitamin A status and liver tissue analysis is rather impractical for routine application in large felids. A biomarker for evaluating overt and subclinical vitamin A deficiency in cheetahs is needed. This study evaluates whether increased calvarial bone thickness can be detected on routine skull radiographs of vitamin A deficient cheetahs compared to unaffected animals, and secondly, evaluates whether there is increased bone thickness in clinically sound captive cheetahs in general compared to wild-living controls. Bone thickness in the neuro- and splanchnocranium was measured in 138 skull radiographs. Significant thickening of the parietal bones was found in latero-lateral radiographs of immature cheetahs (< 12 months) with vitamin A deficiency. This finding may allow a presumptive diagnosis of hypovitaminosis A in immature cheetahs. A general difference in skull thickness between free-living and captive cheetahs was not found.

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Ophthalmic Manifestations of Vitamin A and D Deficiency in Two Autistic Teenagers: Case Reports and a Review of the Literature

Case Reports in Ophthalmology ◽

10.1159/000373921 ◽

2015 ◽

Vol 6 (1) ◽

pp. 24-29 ◽

Cited By ~ 11

Author(s):

Emma Duignan ◽

Paul Kenna ◽

Rosemarie Watson ◽

Susan Fitzsimon ◽

Donal Brosnahan

Keyword(s):

Vitamin A ◽

Dietary Habits ◽

Vitamin A Deficiency ◽

Case Reports ◽

Anterior Segment ◽

Vitamin A Supplementation ◽

Ophthalmic Manifestations ◽

Systemic Manifestations ◽

Time Of Presentation ◽

Hypovitaminosis A

We describe the cases of 2 autistic children with ophthalmic and systemic manifestations of vitamin A deficiency due to food faddism. Although vitamin A deficiency is common in the developing world, reports in developed societies are rare. Our patients presented over a 1-year period. The patients were 14 and 13 years old at the time of presentation and were both found to have marked features of vitamin A deficiency related to unusual dietary habits. Anterior segment signs of xerophthalmia were present in both patients. In addition, patient 1 showed evidence of a rod-predominant retinopathy, which resolved with vitamin A supplementation. Due to its rare occurrence, hypovitaminosis A must be highlighted and anticipated in this cohort.

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Severe Vitamin A Deficiency After Biliopancreatic Diversion

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619888051 ◽

2019 ◽

Vol 7 ◽

pp. 232470961988805 ◽

Cited By ~ 2

Author(s):

Lauren M. Lemieux ◽

Vijaya Surampudi

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Vitamin A ◽

Biliopancreatic Diversion ◽

Unique Feature ◽

Vitamin A Deficiency ◽

Case Series ◽

Nutritional Deficiencies ◽

Severe Vitamin ◽

Deficiency Screening

Biliopancreatic diversion is a surgical procedure that causes weight loss via volume restriction and malabsorption. It is now rarely performed due to the risk of severe nutritional deficiencies including vitamin A. We report a case of severe vitamin A deficiency due to malabsorption from a biliopancreatic diversion procedure for weight loss. By the time the patient presented to our department, she had developed blindness refractory to parenteral vitamin A treatment. A unique feature of her case is the development of a rash with vitamin A injections. This reaction has only been reported in one case series of 3 patients in the published literature. Her case highlights the importance of vitamin deficiency screening in patients after bariatric surgery, and her skin reaction to the injections is a unique side effect that is not frequently observed.

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INCREASED INTRACRANIAL PRESSURE ASSOCIATED WITH PROBABLE VITAMIN A DEFICIENCY IN CYSTIC FIBROSIS

PEDIATRICS ◽

10.1542/peds.46.1.41 ◽

1970 ◽

Vol 46 (1) ◽

pp. 41-46

Author(s):

James P. Keating ◽

Ralph D. Feigin

Keyword(s):

Cystic Fibrosis ◽

Vitamin A ◽

Vitamin A Deficiency ◽

The United States ◽

Anterior Fontanelle ◽

Deficiency Disease ◽

Intestinal Malabsorption ◽

Increased Intracranial Pressure ◽

Appropriate Therapy ◽

Hypovitaminosis A

Two 4-month-old infants with signs of intracranial hypertension associated with vitamin A deficiency are reported. Intestinal malabsorption due to cystic fibrosis was the underlying cause for the hypovitaminosis A. The recognition of vitamin A deficiency was delayed because of failure to appreciate that bulging anterior fontanelle is a sign of deficiency of this vitamin. These cases serve to reemphasize this infrequently reported association and serve to remind the pediatrician that vitamin deficiency disease in the United States is of more than historical interest. Prompt recognition of this syndrome and appropriate therapy can prevent blindness and death.

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Vitamin A Deficiency and Bowel-Associated Dermatosis-Arthritis Syndrome Secondary to Biliopancreatic Diversion for Obesity

Actas Dermo-Sifiliográficas (English Edition) ◽

10.1016/s1578-2190(10)70743-5 ◽

2010 ◽

Vol 101 (10) ◽

pp. 900-902

Author(s):

S. Gómez-Diez ◽

A. Mas Vidal ◽

T. Soler ◽

F. Vázquez-López ◽

N. Pérez Oliva

Keyword(s):

Vitamin A ◽

Biliopancreatic Diversion ◽

Vitamin A Deficiency

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Bilateral corneal ulcer and hypovitaminosis A: a case report

International Journal of Clinical and Experimental Ophthalmology ◽

10.29328/journal.ijceo.1001039 ◽

2021 ◽

Vol 5 (2) ◽

pp. 023-024

Author(s):

Chaimae Khodriss ◽

Ahmed Bennis ◽

Fouad Chraibi ◽

Meriem Abdellaoui ◽

Idriss Benatiya Andaloussi

Keyword(s):

Case Report ◽

Vitamin A ◽

Corneal Ulcer ◽

Vitamin A Deficiency ◽

Hypovitaminosis A

Vitamin A is a fat-soluble discovered in 1913. Hypo-vitaminosis A can cause blindness by various mechanisms. The aim of this case report is to emphasize the severity of Vitamin A deficiency and its local consequences on the eyes causing corneal ulcerations, abscess and even blindness.

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