A 43-year-old woman presented with worsening night blindness. She also complained of paraesthesia of the lower limbs and numbness. She had developed weakness in her lower limbs and had difficulty walking. She had been under-weight as a child but had later gained weight in her teenage. She went on a diet but gained weight later again. She underwent sleeve gastrectomy and duodenal switch surgery to treat her obesity.
She had a history of osteoporosis, diarrhea, and malabsorption. Investigation : Serum vitamin A level: 1.24 μmol/L Vitamin E: 14.1 μmol/L Copper: 5.7 μmol/L Ceruloplasmin: 0.14 g/L Hydroxyvitamin D 2 : 1.00 ng/mL Total vitamin D (D 2 +D 3 ) level: 61 ng/mL Retinal dysfunction affecting rod photoreceptors was detected. No evidence of macular involvement was found. Her nerve conduction studies were normal and there was no evidence of peripheral neuropathy. What can be done…
