Acrodermatitis Enteropathica During Adequate Enteral Nutrition

Abstract

Acrodermatitis enteropathica is a rare skin disorder of zinc deficiency. This case report describes a 91-year-old female nursing home resident who presented with a skin eruption resembling acrodermatitis enteropathica while receiving adequate enteral nutrition (EN) via a percutaneous gastrostomy tube. A low zinc level of 36 mcg/dL confirmed zinc deficiency, and treatment with oral zinc sulfate 220 mg 3 times a day resulted in rapid resolution of the skin lesions. This case supports the notion of close monitoring of patients on long-term EN for clinical manifestations of zinc deficiency, especially in the presence of an unexplained skin rash. Although micronutrient deficiencies are more prevalent in underdeveloped countries and with patients receiving parenteral nutrition, these deficiencies should be kept in mind for patients in developed countries as well as patients receiving EN.

Zinc

“…There are relatively few reports of Zn deficiency occurring in enterally fed patients. However, clinically overt deficiency has been reported in patients receiving EN in whom the level of Zn provision had been considered sufficient to meet requirements 108 – 110 . These cases emphasize the importance of continuous monitoring of patients on long‐term EN and keeping Zn provision under close review.…”

Acrodermatitis enteropathica in three siblings

“…[2,4] We assumed that our patients had congenital AE due to early onset of the lesions, no acquired additional diseases, and positive family history. However, we could not perform any further investigation to detect the exact mechanism of zinc malabsorption.…”

“…The lesions are accompanied with decreased hair and nail growth. [1,4] The diagnosis of AE can be made based on the clinical, histopathological findings, and laboratory abnormalities. A serum zinc level <50 mg/dl is indicative of AE, but not mandatory.…”

“…AE can be seen in patients with normal zinc level. [4] Zinc-dependent enzymes such as alkaline phosphatase can be decreased. [2,5] In our cases, zinc level was decreased and alkaline phosphates were elevated.…”

“…[1,2] The AE patients require lifelong zinc supplementation therapy to prevent further lesions. [1,4] …”