http://content.nejm.

org/cgi/content/full/342/12/897
Correspondence
Volume 342:897-898 !rch 23" 2### $um%er 12
&lindness in ! 'trict Veg!n

(ools !nd 'er)ices
- *dd to +erson!l *rchi)e
- *dd to Cit!tion !n!ger
- $otif, ! -riend
- .-m!il /hen Cited
ore 0nform!tion
- +u%ed Cit!tion
(o the .ditor: Veget!ri!ns !re !t ris1 for nutrition!l deficienc, if the, do not recei)e )it!min
supplement!tion. /e report ! c!se of se)ere %il!ter!l optic neurop!th, in ! p!tient 2ho h!d %een
! )eg!n for m!n, ,e!rs !nd 2ho did not t!1e )it!min supplements. (he p!tient" ! 33-,e!r-old
m!n 2ho h!d st!rted ! strict )eget!ri!n diet !t the !ge of 2# ,e!rs" 2!s referred for e)!lu!tion of
progressi)e )isu!l loss. 30mpro)ed he!lth3 2!s the re!son for the diet" 2hich cont!ined no eggs"
d!ir, products" fish" or other sources of !nim!l proteins. 4e did not smo1e or use !lcohol" !nd his
medic!l histor, 2!s unrem!r1!%le.
.5!min!tion sho2ed se)ere %il!ter!l optic neurop!th, 2ith )er, poor )ision 6less th!n 2#/4## in
%oth e,es7" centr!l scotom!t!" d,schrom!topsi!" !nd !troph, of the optic dis1s. /e found no
e)idence of ! compression of the )isu!l p!th2!, or of ! to5ic" infectious" or infl!mm!tor, c!use
of the %lindness. itochondri!l-8$* !n!l,sis sho2ed no mut!tion for 9e%er:s heredit!r, optic
neurop!th,. ;n neurologic e5!min!tion" there 2!s ! sensor, peripher!l neurop!th," confirmed %,
electroph,siologic studies. (he cere%rospin!l fluid 2!s norm!l" including the opening pressure.
(he rem!inder of the gener!l e5!min!tion sho2ed no !%norm!lities.
(he pl!sm! le)el of fol!te 2!s lo2 6<.4 nmol per liter= norm!l r!nge" 7.< to 287" !s 2ere the le)els
of )it!min &1 64 nmol per liter= norm!l r!nge" > to 4#7 !nd )it!min &12 6114 pmol per liter= norm!l
r!nge" 1<# to 72#7. (here 2ere !lso deficiencies of )it!mins *" C" 8" !nd . !nd ?inc !nd
selenium" %ut pl!sm! le)els of iron" ferritin" )it!min &>" !nd nicotin!mide 2ere norm!l. (he
p!tient h!d meg!lo%l!stic !nemi! 6hemoglo%in le)el" 1#.< g per liter= me!n corpuscul!r )olume"
11# @m37" 2hich 2!s not due to pernicious !nemi! 6there 2ere no !ntiAp!riet!l-cell or !ntiA
intrinsic-f!ctor !nti%odies" upper g!strointestin!l endoscop, sho2ed norm!l findings" !nd multiple
%iopsies sho2ed no g!stric !troph,7 or other c!uses of m!l!%sorption. *fter tre!tment 2ith
intr!muscul!r )it!min &12 61### @g d!il, for one 2ee17 !nd or!l multi)it!min supplement!tion"
the hemoglo%in le)el 2!s norm!l !nd the sensor, neurop!th, h!d dis!ppe!red" %ut there 2!s no
reco)er, of )ision.
Vit!min &12 deficienc, in )eget!ri!ns m!, c!use neurologic distur%!nces.1"2 oreo)er"
deficiencies of )it!mins &12 !nd &1 m!, %e responsi%le for optic neurop!th, !ssoci!ted 2ith
nutrition!l f!ctors.3 *m%l,opi! !nd p!inful neurop!th, h!)e %een reported in c!ses of diet!r,
depri)!tion in prisoners during /orld /!r 00" !nd more recentl," diet!r, f!ctors 2ere noted in the
Cu%!n epidemic of optic neurop!th,.4 (he optic neurop!th, in our p!tient 2!s !pp!rentl, rel!ted
to deficiencies of )it!mins &12 !nd &1" %ut other !ssoci!ted deficiencies m!, h!)e h!d ! role.
Vit!min supplement!tion is essenti!l in persons 2ho !dhere to ! strict )eget!ri!n diet" especi!ll,
%ec!use )it!min deficiencies m!, c!use se)ere" irre)ersi%le optic neurop!th,.
8!n ile!" .8.
$!th!lie C!ssou5" .8.
+huc 9e4o!ng" .8." +h.8.
Broupe 4ospit!lier +itiCA'!lpDtriEre
7<><1 +!ris C.8.F 13" -r!nce
Geferences
1. *sh1en!?i '" /eit? G" V!rs!no 0" imouni . Vit!min &12 deficienc, due to ! strictl,
)eget!ri!n diet in !dolescence. Clin +edi!tr 6+hil!7 1987=2>:>>2->>3.
2. Gen!ult -" Verstichel +" +louss!rd H+" Costil H. $europ!th, in t2o co%!l!min-deficient %re!st-
fed inf!nts of )eget!ri!n mothers. uscle $er)e 1999=22:2<2-2<4. ICrossGefJIedlineJ
3. iller $G" $e2m!n $H. /!lsh !nd 4o,t:s clinic!l neuro-ophth!lmolog,. <th ed. Vol. 1.
&!ltimore: /illi!ms K /il1ins" 1998:>>3-79.
4. (he Cu%! $europ!th, -ield 0n)estig!tion (e!m. .pidemic optic neurop!th, in Cu%! -- clinic!l
ch!r!cteri?!tion !nd ris1 f!ctors. $ .ngl H ed 199<=333:117>-1182. I-ree -ull (e5tJ