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[Acute reversible night blindness caused by vitamin A deficiency in pancreatic carcinoma].

BACKGROUND
Vitamin A deficiency is a leading cause of blindness in childhood in the developing countries. In developed countries xerophthalmia occurs mainly as secondary hypovitaminosis due to malabsorption in chronic alcoholism or intestinal disorders.


PATIENT AND METHODS
A 24-year-old female patient complained of night blindness since one week. There was a history of pancreas tail resection combined with radiation due to a papillary low grade cystic carcinoma at the age of 15. During a review period of 9 years of follow-up there was a slow disseminated metastatic spread including the liver. Despite a progressive tumor cachexia the patient was practising a profession. Visual acuity was 20/20 OU with normal visual fields. Dark adaptation was reduced to one log unit and scotopic electroretinography was extinguished. Serum vitamin A level was reduced to 75 ng/ml (normal range 400-700 ng/ml).


RESULTS
Under vitamin A substitution dark adaption and scotopic electroretinography normalized and night blindness disappeared within 7 days.


CONCLUSIONS
In malabsorption syndromes, especially in combination with liver manifestations, xerophthalmia should be considered as a potential complication. Vitamin A substitution should be administered if necessary. In cases of malignant tumors differential diagnosis includes the cancer associated retinopathy (CAR).