Flipping the Switch

This case report describes a 43 year old woman with recurrent UTIs and a history of biliopancreatic diversion with duodenal switch surgery, who was found to have keratinizing desquamative squamous metaplasia of the renal pelvicalyceal systems due to severe vitamin A deficiency. Despite normal body weight, her transdermal multivitamin patch failed to prevent fat soluble vitamin malabsorption. Diagnostic imaging and ureteroscopy revealed urothelial sloughing and plaques, initially mistaken for infection or cancer. High dose vitamin A supplementation resolved the urothelial abnormalities and recurrent UTIs over 15 months. The case underscores the importance of postoperative nutritional monitoring after malabsorptive bariatric procedures and highlights the rare but critical role of vitamin A in maintaining urothelial integrity.

This case report describes a 43 year old woman with recurrent UTIs and a history of biliopancreatic diversion with duodenal switch surgery, who was found to have keratinizing desquamative squamous metaplasia of the renal pelvicalyceal systems due to severe vitamin A deficiency. Despite normal body weight, her transdermal multivitamin patch failed to prevent fat soluble vitamin malabsorption. Diagnostic imaging and ureteroscopy revealed urothelial sloughing and plaques, initially mistaken for infection or cancer. High dose vitamin A supplementation resolved the urothelial abnormalities and recurrent UTIs over 15 months. The case underscores the importance of postoperative nutritional monitoring after malabsorptive bariatric procedures and highlights the rare but critical role of vitamin A in maintaining urothelial integrity.