da Rocha Lima Breno, Pichi Francesco, Lowder Careen Y
Cleveland Clinic Cole Eye Institute, 9500 Euclid Avenue i-32, Cleveland, OH, 44195, USA.
Int Ophthalmol. 2014 Oct;34(5):1141-4. doi: 10.1007/s10792-014-9940-x. Epub 2014 Apr 9.
Signs of malnutrition are common clinical features in Crohn's disease; and bowel resection, commonly needed in these cases, can aggravate malnutrition. These patients are at risk of developing vitamin A deficiency, which can lead to night blindness. We present a 60-year-old male, with history of Crohn's disease and multiple resections for strictures and fistulas leading to short bowel syndrome, with progressive bilateral loss of night vision (nyctalopia). Serum vitamin A level was markedly depleted (11 µg/dL, reference 20-120 µg/dL), and full-field electroretinogram testing demonstrated extinguished scotopic (rod function) responses and decreased amplitudes of photopic responses on 30 Hz flicker (cone function). He was started on vitamin A supplementation (initially intramuscular). His vitamin A level was back to normal (78 µg/dL), and night vision problems subjectively improved. Patients with Crohn's disease should be inquired about night vision problems. The presence of nyctalopia should prompt vitamin A level measurement and ophthalmology referral for further evaluation.
营养不良的体征是克罗恩病常见的临床特征；而在这些病例中通常需要进行的肠道切除术会加重营养不良。这些患者有患维生素A缺乏症的风险，这可能导致夜盲。我们报告一名60岁男性，有克罗恩病病史，因狭窄和瘘管多次接受手术，导致短肠综合征，出现进行性双侧夜视力丧失（夜盲）。血清维生素A水平显著降低（11微克/分升，参考值20 - 120微克/分升），全视野视网膜电图测试显示暗视（视杆细胞功能）反应消失，30赫兹闪烁光下明视反应（视锥细胞功能）振幅降低。开始给他补充维生素A（最初为肌肉注射）。他的维生素A水平恢复正常（78微克/分升），主观上夜视力问题有所改善。应询问克罗恩病患者是否存在夜视力问题。出现夜盲应促使检测维生素A水平并转诊至眼科进行进一步评估。
