# Vitamin A Deficiency in Children With Neurodevelopmental Disorders: Case Reports of Ocular and Urinary Tract Complications in Two Patients

## TL;DR

This paper reports two cases of vitamin A deficiency in children with neurodevelopmental disorders, showing severe eye and urinary tract symptoms that improved with treatment.

## Contribution

The paper highlights the rare but severe coexistence of ocular and urinary tract complications due to vitamin A deficiency in children with neurodevelopmental disorders.

## Key findings

- Two pediatric cases of vitamin A deficiency showed ocular and urinary tract symptoms, including keratitis and urethral keratosis.
- Treatment with vitamin A and zinc led to significant improvement in symptoms, though visual acuity recovery was limited in one case.
- The cases emphasize the importance of early recognition and interdisciplinary management of vitamin A deficiency in children with dietary restrictions.

## Abstract

Vitamin A deficiency (VAD) is a nutritional disorder that is predominantly observed in developing countries due to malnutrition. However, it can also occur in developed countries, particularly in children with neurodevelopmental disorders associated with avoidant and restrictive food intake disorder (ARFID) or malabsorption. The clinical manifestations of VAD include ocular complications, such as night blindness, xerophthalmia, and keratomalacia, as well as systemic effects, including impaired immunity, growth retardation, and increased susceptibility to infections. While there has been notable attention on the association between VAD and urinary tract infections, reports detailing their coexistence are limited. This report presents two pediatric cases of VAD in children with neurodevelopmental disorders who exhibited ocular and urinary tract symptoms. The first case involves a nine-year-old male patient who presented with progressive visual impairment, photophobia, and a medical history of urethral stenosis. A detailed examination revealed severe visual acuity loss, diffuse keratitis, optic nerve pallor, and keratin deposits in the bladder. The second case pertains to a six-year-old male patient who exhibited symptoms such as photophobia, recurrent urinary tract infections, and urethral keratosis. Upon examination, corneal leukoplakia and peripheral opacity were observed. A history of selective eating was observed in both patients, and serum vitamin A levels were used to confirm the diagnosis of VAD. Treatment with vitamin A and zinc resulted in significant improvement in ocular and urinary symptoms. Photophobia exhibited a marked improvement in both cases, although visual acuity recovery was limited in Case 1. These cases underscore the gravity of VAD, a condition that, though rare in developed countries, can manifest with severe and diverse symptoms, particularly in children with developmental disorders. The underlying mechanisms involve epithelial keratinization and immune dysfunction, which increase infection susceptibility. Early recognition and interdisciplinary collaboration are crucial for timely diagnosis and management. Clinicians are advised to consider VAD in patients presenting with ocular or systemic symptoms, particularly when urinary tract infections and dietary insufficiencies are concurrently present. These findings underscore the necessity of a multidisciplinary approach to address VAD, ensuring enhanced outcomes and the prevention of complications.