Since the discovery of
vitamins, there has been an increasing interest at relating
vitamins with particular diseases. In particular, for
vitamin A its singular importance has been determined in multiple vital functions, and its relationship with diseases, both in deficit and in excess, is nowadays completely demonstrated. In developed countries,
vitamin deficiency-related diseases have been greatly reduced; however, in some patients with particular features they must be kept in mind. This is the case of a 45 year-old man, with a history of chronic
alcoholism, non
insulin-dependent diabetes meIlitus and
cholecystectomy with a high biliary drainage secondary to
emphysematous cholecystitis and perivesicular
abscess. He complains of bilateral ocular
pain,
photophobia, and decreased visual acuity besides a history of pasty, sticky and foul-smelling feces. He is admitted in the Ophthalmology Department and bilateral corneal ulceration is diagnosed. A consultation to the Nutrition Department is made because of
cachexia. Severe caloric and
mil protein hyponutrition is observed with a BMI of 18.2 and a 23%
weight loss for the last 6 months, fat-soluble
vitamins (A, D and E) deficit, mild fat malabsorption, and macrocytic and
hypochromic anemia. The patient's diet is supplemented with a special hyperproteinic and hypercaloric diet for diabetics, deficient
vitamins and pancreatic
enzymes to improve absorption are administered, and glycemia is controlled with
insulin. Four months later, the patient is assessed and has a BMI of 20,
anemia has resolved and from an ophthalmologic viewpoint the course is favorable, the
ulcers improve and visual acuity is almost completely recovered. In chronic alcoholic patients with a low dietary intake and clinical complications with nutritional repercussions (
pancreatitis that produces malabsorption or
cholecystectomy with biliary percutaneous drainage) we should not forget that
micronutrients deficits may explain the etiology of other associated diseases, in the present case corneal ulceration.