Review Question - QID 105407

This patient's Bitot spots, night blindness, and eye dryness is consistent with vitamin A deficiency in the setting of poor nutrition. Follicular hyperkeratosis is also seen in vitamin A deficiency.

Vitamin A deficiency occurs because of poor intake or malabsorption. Night blindness and xerophthalmia (which refers to conjunctival and corneal dryness) are symptoms of vitamin A deficiency. In some cases, xerophthalmia may present with Bitot spots, which are characterized by squamous metaplasia of the corneal epithelium (Figure A). Follicular hyperkeratosis is skin dryness caused by loss of sebaceous gland function combined with keratin buildup in the hair follicles. This primarily occurs on the shoulders, buttocks, and extensor surfaces. Follicular hyperkeratosis, as well as alopecia and frequent infections, are also seen with vitamin A deficiency.

Figure/Illustration A shows Bitot spots (red arrow) which are caused by keratin buildup.

Incorrect Answers
Answer 1: Angular chelitis is a common finding in vitamin B2 (riboflavin) deficiency which presents with stomatitis and a diffuse rash as well.

Answer 2: Bleeding gums, follicular hemorrhages, and easy fractures can be seen in scurvy or vitamin C deficiency secondary to decreased collagen production.

Answer 4: Megaloblastic anemia can be seen in folate deficiency which is common in alcoholics. It can also be seen in vitamin B12 deficiency in addition to dorsal column dysfunction (such as impaired proprioception and vibration sensation).

Answer 5: Nystagmus, ataxia, and ophthalmoplegia can be seen in Wernicke syndrome which occurs secondary to thiamine deficiency.

Bullet Summary:
Follicular hyperkeratosis, night blindness, and Bitot spots can be seen in vitamin A deficiency.