Symptomatic vitamin A deficiency in a paediatric patient with short bowel syndrome

Vitamin A deficiency-which leads to xerophthalmia-is rarely observed in developed countries. However, it can be triggered by malabsorption conditions such as short bowel syndrome (SBS). Herein, we present an early-adolescent boy with hypoganglionosis-related SBS receiving long-term supplemental parenteral nutrition who presented with night blindness, bilateral conjunctival xerosis and Bitot's spots. The patient's serum retinol level was 4.2 (normal: > 20) µg/dL. Thus, 100 000 IU of vitamin A was administered intramuscularly on days 1, 2 and again after 2 weeks. The ocular signs and night blindness resolved. Paediatric patients with SBS may develop symptomatic xerophthalmia despite routine supplemental or total parenteral nutrition. Therefore, regular ophthalmologic examinations are recommended. However, in the case of any ocular abnormality-such as night blindness and conjunctival xerosis-clinicians should immediately facilitate the measurement of serum retinol levels. Intramuscular high-dose vitamin A is an effective treatment if malabsorption prevents adequate enteral uptake.