A case of vitamin A deficiency caused by biliary dilatation and choledocholithiasis in a hemodialysis patient

Purpose : To report a case of vitamin A deficiency caused by biliary dilatation and cho-ledocholithiasis in a hemodialysis patient. Case : A 65-year-old woman presented with night blindness. She had been diagnosed with choledocho¬lithiasis, on maintenance hemodialysis two years before. Finding : Corrected visual acuity was 1.0 in both eyes. Funduscopy showed diffuse gray-white spots. Visual field examination did not reveal any significant difference, and the flash electroretinogram showed decreased amplitude. Optical coherence tomography (OCT) showed absence of an ellipsoid zone (EZ) and an inter digitation zone (1Z). Vitamin A in the scrum was 19 IU/dl. These findings led to the diagnosis of vitamin A deficiency. Night blindness disappeared after seven days of peroral vitamin A. The electroretinogram and OCT showed improvement. Conclusion : Night blindness in the presented case was apparently due to malabsorpion by biliary dilata¬tion, choledocholithiasis and hypozincemia in hemodialysis. The presence of hypervitaminosis must be considered in a hemodialysis patient.