lethargy, and refusal of feed for two days. He was born at term with mother having no significant antenatal history. He had progressed well until eight weeks of age when he was treated as seborrhoeic dermatitis for a diffuse rash which developed after an upper respiratory tract infection. As this did not improve a tentative diagnosis of acrodermatitis enteropathica was made and zinc supplement was started with some improvement. At 10 weeks of age he had one episode of generalised seizures that was treated with phenobarbitone, which had to be increased as he had two more episodes of convulsions in the same week. Computed tomography scan of cranium at that time was reported normal. His elder sibling had died at five months of age due to pneumonia and skin lesions. On admission, he was drowsy with tachypnoea, responding to only painful stimuli. There were no dysmorphic features. He had conjunctivitis,
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