Acquired acrodermatitis enteropathica after abdominal surgery: Case report

Abstract

Introduction: The treatment of acquired acro­dermatitis enteropathica involves zinc supple­mentation; however, further research is required to establsih the optimal dose and duration of the supplementation.Case presentation: Female patient with a history of gastric bypass, intestinal resection, and 2 months of skin rash that required biopsy with histological findings compatible with der­matitis associated to nutritional deficiency. She received elemental zinc supplementation for 11 days, achieving improvement in skin le­sions. She was later readmitted twice due to reactivation of the disease with the need to restart zinc supplementation. At the time of this study, she had been receiving oral elemental zinc treatment for 3 years, at doses of up to 240 mg/day.Discussion: In patients with gastric bypass and intestinal malabsorption, the usual zinc dose of 8-11 mg/day may be insufficient and put patients at risk for acquired acrodermatitis enteropathica. In similar case reports, the sup­plementation dose ranges from 2 mg/kg/day of venous elemental zinc to 300 mg/day orally, while the duration of supplementation has not been established.Conclusions: Oral supplementation for 3 years with a maximum dose of 240 mg/day has been adequate for controlling the disease. Monitoring blood zinc levels and physical examination of the skin have been key factors for adjusting the dose to be supplied.

Acrodermatitis Enteropathica–Like Dermatosis After Whipple Procedure

“…The exact duration and dose of supplementation are unclear, but 15 to 30 mg/d or 3 mg/kg per day has been suggested 7 …”

“…The exact duration and dose of supplementation are unclear, but 15 to 30 mg/d or 3 mg/kg per day has been suggested. 7 Zinc deficiency can predispose to infections. Furthermore, it might play a role in the integrity of pulmonary epithelial cells and protect the pulmonary epithelial lining.…”

“…These values were surprisingly high as compared with the levels reported in other types of surgery. [7][8][9][10] The presence of malignancy (n = 20, 49%), the type of surgery, or the lymph node involvement had no influence on the PAM values. The patients who had to undergo reoperation (n = 10) because of a complication showed a 7-point decrease from preoperative to postoperative PAM values (range, −16 to 3), whereas patients who did not need reoperation had no difference between preoperative to postoperative PAM values (P < 0.05; Fig.…”