Answer: A. Vitamin A deficiencies are rare in the United States. However, they can occur in patients with disorders associated with fat malabsorption, such as cystic fibrosis and other causes of pancreatic insufficiency, celiac disease, cholestasis liver disease such as primary biliary cholangitis, small bowel Crohn disease, or short bowel syndrome, and in patients who have undergone certain types of bariatric surgery (biliopancreatic diversion with duodenal switch). If patients with these conditions have difficulty with fat absorption and are experiencing vision changes, particularly in low light or at night, they should be evaluated for vitamin A deficiency.

Based on Paul’s vision changes, especially his difficulty going from light to dark and dark to light, the appearance of yellow hue at sunset throughout his entire vision field, the possible blind spot, and given his vitamin A level of 4.4 mcg/dL, he was diagnosed with vitamin A deficiency.

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