A 50-year-old male who underwent a biliopancreatic diversion of Scopinaro due to morbid obesity in January 2004.
The patient presents with hepatic steatosis and malalignment syndrome.
He is being treated with vitamin B12 for chronic anemia and vitamin K due to decreased prothrombin activity.
In January 2006 a pyeloinfundibulonephrolithotomy with postoperative urinary fistula was performed.
In April 2006, the patient was referred to the Palliative Care Unit for a nocturnal blindness of progression over a 3-month period.
The patient also reported foreign body sensation and red eye.
Upon examination, visual acuity was one in both eyes.
The examination with a cleft palate showed a very decreased BUT, conjunctival xerosis and Bitot spots in both eyes.
A fine corneal connective epithelial punctate could also be observed in fluorescein staining.
Schirmer's test I under anesthesia showed values greater than 15 mm. Ophthalmoscopy showed a whitefly in the medial periphery without macular involvement.
The plasmatic level of consciousness was normal mg/l (normal level 0.30-0.8 mg/l).
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Because of the potential severity of the condition, oral treatment with vitamin A and pancreatic enzymes was started to favor its absorption while waiting for intramuscular treatment, with no improvement.
Concomitantly, due to complicated nephrolithiasis (intrarenal abscess), the patient underwent nephrectomy with intense bleeding, which required five concentrates associated with severe bleeding.
After this process, the patient reported a slight improvement in symptoms, despite having suppressed oral treatment by postoperative fasting.
Finally, 300,000 IU of vitamin A were administered intramuscularly with immediate improvement of subjective symptoms, although the manifestations disappear within three months.
