Acquired acrodermatitis enteropathica due to zinc‐depleted parenteral nutrition

Abstract

Well-known causes of zinc deficiency, also referred to as acrodermatitis enteropathica (AE), include defects in intestinal zinc transporters and inadequate intake, but a rare cause of acquired zinc deficiency discussed here is an iatrogenic nutritional deficiency caused by parenteral nutrition administered without trace elements. While zinc-depleted parenteral nutrition causing dermatosis of acquired zinc deficiency was first reported in the 1990s, it is now again relevant due to a national vitamin and trace element shortage. A high index of suspicion may be necessary to diagnose zinc deficiency, particularly because early clinical findings are nonspecific. We present this case of acquired zinc deficiency in a patient admitted to a pediatric intensive care unit for respiratory distress and atypical pneumonia, who subsequently developed a severe bullous eruption due to iatrogenic zinc deficiency but was treated effectively with enteral and parenteral zinc supplementation, allowing for rapid re-epithelialization of previously denuded skin. K E Y W O R D S acrodermatitis enteropathica, bullous, trace element shortage, zinc deficiency How to cite this article: Wiznia LE, Bhansali S, Brinster N, Al-Qaqaa YM, Orlow SJ, Oza V. Acquired acrodermatitis enteropathica due to zinc-depleted parenteral nutrition. Pediatr

Acquired Zinc Deficiency Mimicking Acrodermatitis Enteropathica in a Breast-Fed Premature Infant

“…Thus, skin lesions are typical manifestations of the zinc deficiency [1,9]. They consist, as in our case, in papulo-squamous, erosive eruptions involving periorificial, anogenital, and acral areas [12] (Figure 1a-d). As MRSA coexisted with zinc deficiency, it could have worsened the rash.…”

Iron deficiency in sepsis patients managed with divided doses of iron dextran: a prospective cohort study

“…Iron deficiency is one of the most frequent deficiencies worldwide. It is mainly due to relatively low intake with unbalanced diet and no supplementation 32 . Setting the ground for IDA prevalence in general population, critically ill patients hospitalized in the ICU are endangered by aggravation of the disorder or its development de novo.…”

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Scaly plaques in a malnourished patient

“…1 Risk factors for decreased intake include alcoholism, long-term total parental nutrition, vegetarian diets, and diets high in mineral-binding phytates. 1,3 Patients with impaired absorption or increased excretion include those with intestinal malabsorption, liver disease, renal disease, Crohn disease, cystic fibrosis, and a history of gastric bypass surgery. [2][3][4][5] The diagnosis of acquired acrodermatitis enteropathica is largely based on clinical presentation and supported by a serum zinc less than 50 μg/dL.…”

“…1,3 Patients with impaired absorption or increased excretion include those with intestinal malabsorption, liver disease, renal disease, Crohn disease, cystic fibrosis, and a history of gastric bypass surgery. [2][3][4][5] The diagnosis of acquired acrodermatitis enteropathica is largely based on clinical presentation and supported by a serum zinc less than 50 μg/dL. Skin biopsy is rarely necessary but can be diagnostic of a nutritional-deficiency dermatitis that is not specific to acrodermatitis enteropathica.…”