Zinc Deficiency with Acrodermatitis Enteropathica-like Eruption After Pancreaticoduodenectomy

Abstract

Pancreaticoduodenectomy (PD) is the standard operation for periampullary lesions. Most reports have focused on the clinical outcome, complications and tumor recurrence after PD. Few studies have focused on the nutritional sequelae that result from the extended resection of the upper gastrointestinal tract and disruption of the normal physiologic process of digestion. Zinc is absorbed mainly in the duodenum and proximal jejunum, which are removed during PD. Herein, we report two patients who experienced zinc deficiency with acrodermatitis enteropathica-like eruption, alopecia, glossitis and nail dystrophy after PD. The lesions improved dramatically after supplementation with zinc sulfate, pancreatic enzyme and diet instructions. No symptoms related to zinc deficiency were noted on follow-up after nutritional instructions had been given to the patients.

Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery

“…Severe zinc deficiency in a nonbariatric setting can induce a dermatologic eruption, alopecia, glossitis and nail dystrophy. 82 Intake of high doses of zinc can induce copper deficiency. In addition, the occurrence of copper deficiency has been reported in patients after RYGB.…”

Preparation of Pectin–ZnO Nanocomposite

“…It has been estimated that more than 50% of poor children and 30% of non-poor children get <70% of the recommended dietary allowance of Zn [6-9]. The main reason may be the presence of phytate in staple foods such as cereals and pulses; phytate has a strong negative effect on Zn absorption from composite meals.…”

Acrodermatitis enteropathica‐like dermatosis associated with combined deficiency of zinc and amino acids

“…The dermatitis is markedly improved with the intake of an oral zinc supplement. The AE‐like eruption has been reported in patients with digestion problems after operation on the gastrointestinal tract 2,3 . AE‐like dermatosis has been reported occasionally in some cases of metabolic disease, including neonatal citrullinemia and ornithine transcarbamylase deficiency 4–6 .…”

“…As the skin lesions of the presented case worsened with zinc supplementation and were improved by the addition of amino acid supplementation, we can conclude that the clinical manifestations of the patient were attributable to a combined deficiency of amino acid and zinc. Zinc transport is carried out predominantly by amino acids, including albumin and α 2 ‐macroglobulin 2 . It is therefore speculated that zinc deficiency accompanies amino acid deficiency.…”