Vitamin A deficiency-associated corneal perforation in a boy with autism spectrum disorder: A case report and review of the literature

Abstract Background Malnutrition and vitamin deficiency are growing concerns in the clinical management of children with autism spectrum disorder (ASD). We herein report the case of a boy with ASD who developed vitamin A deficiency during follow-up. Case report The patient was a 7-year-old boy who was diagnosed of ASD and developmental delay at age 18 months. He developed convulsions associated with hypocalcemia and vitamin D deficiency at 3 years of age. Although vitamin D supplementation was continued, he was only able to take rice, green tea, and fried potatoes from 3 years of age. He started rubbing his eyes, and rejected to open his eyes from 9 months before. An ophthalmologic examination showed bilateral corneal ulcers and right corneal perforation. Vitamin A was immediately supplemented with nasogastric tube; however, his right eye was surgically enucleated against the persistent infection. Review of the literature Our search of the relevant literature from 1993 to 2020 identified 11 cases with ASD (5 to 17 years of age), who developed vitamin A deficiency due to malnutrition. Only 4 cases (36%) showed a full recovery in visual acuity. Conclusion Vitamin A deficiency frequently causes irreversible visual impairment in children with ASD. Vigilant monitoring of vitamin levels prevents unfavorable outcomes in children with ASD and difficulty in food intake.