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A 64-yr-old man had a 25-yr H/o Crohn&rsquo;s disease involving multiple bowel resections for fistulae and obstruction. Since his operation, he has experienced frequent abdominal cramps and 4 to 8 stools daily. He was managed on a low-fat diet with medium-chain triglyceride, multivitamin, iron, calcium and magnesium oral supplements.&nbsp;On initial physical examination, the abnormal findings were marked cachexia, pigmentary degeneration of the retina and massive bilateral visual field scotomata preserving only 10% of central vision, as shown in the figure.&nbsp;

He also had a generalized motor weakness in proximal than distal muscle groups and a broad-based gait with marked ataxia, brisk reflexes, and a bilateral Babinski response. In addition, proprioception was moderately diminished in all extremities. All Laboratory values were average except vitamin E. serum vitamin E levels were 0.03 mg/dl. Electroretinography revealed a marked decrease of the A and B wave amplitudes under both scotopic and photopic conditions and an increased response latency.&nbsp;

His vitamin E status was corrected with 3200 mg of intramuscular tocopherol acetate. As a result, the patient&rsquo;s vitamin E status eventually normalized, and during this same period, he noted a gradual improvement in his vision and gait. In addition, a neurological reassessment showed objective improvement of both his visual fields.

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A senior citizen suffering from Crohn’s disease along with Vitamin E deficiency.