Xeropthalmia and optic neuropathy secondary to ARFID: a case report

Abstract

Background: Patients with avoidant/restrictive food intake disorder (ARFID) commonly present with loss of weight or faltering growth in the setting of poor nutrition. However, patients with ARFID can present with micronutrient deficiencies without weight loss. In patients with ARFID, clinicians should be vigilant for micronutrient deficiencies and their presentations.

Case presentation: We report a unique case of ARFID in a twelve-year-old girl, who developed micronutrient deficiencies and presented with acute visual loss with a preceding history of impaired night vision. Ophthalmic examination revealed xerophthalmia and bilateral optic neuropathy. Investigations showed severe Vitamin A and folate deficiencies which accounted for her clinical findings. In addition, she was also found to have low Vitamin B12, copper, and Vitamin D levels. She had a history of selective eating from a young age with a diet consisting largely of carbohydrates, with no regular intake of meat, dairy, fruit and vegetables. This was not driven by weight or body image concerns. The patient's symptoms improved significantly with appropriate vitamin replacement and continued multidisciplinary care.

Conclusions: This report describes a patient with ARFID presenting with visual complaints. In this case, the selective eating behaviours resulted in xeropthalmia and optic neuropathy. Micronutrient deficiencies are uncommon in developed countries. When these deficiencies are suspected, eating disorders, such as ARFID, should be considered. Similarly, clinicians caring for patients with restrictive eating disorders including ARFID should be familiar with the clinical presentations of various micronutrient deficiencies and consider evaluation and treatment for micronutrient deficiencies when clinically indicated.

Keywords: Avoidant/restrictive food intake disorder (ARFID); Case report; Optic neuropathy; Vitamin A; Vitamin deficiency; Xeropthalmia.

Fig. 1

a: Colour photograph of the anterior segment showing xerophthalmia as evidenced by the Bitot’s spots (as marked by asterisk), collections of keratinized epithelium forming patches of foamy whitish opaque deposits, giving a shiny irregular reflex on the conjunctiva. b: Colour photograph of the cornea taken using cobalt blue light after fluorescein staining. Epithelial defects stain yellow. This photograph shows the multiple punctate epithelial erosions, more extensive inferiorly, due to severe dry eye

Fig. 2

Fundal photographs showing bilateral disc swelling

Fig. 3

MRI imaging showing increased T2 signal intensity in the intra-orbital segment of the left optic nerve (Fig. 3a), with minimal enhancement noted on post-contrast T1 sequences (Fig. 3b)