Transient symptomatic zinc deficiency in a breast‐fed African infant: case report and literature review

Barruscotti, Stefania; Vassallo, Camilla; Giorgini, Chiara; Savasta, Salvatore; Licari, Amelia; Marseglia, Gian Luigi; Brazzelli, Valeria

doi:10.1111/ijd.14206

Cited by 4 publications

(2 citation statements)

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“…TSZD, the acquired form, is a self-limited disease primarily observed in exclusively or partially breastfed premature and low birth weight infants[ 15 – 17 , 8 ], but it has also been reported in full-term infants [ 18 – 20 , 7 ]. Compared to AE, the etiologies of TSZD are more diverse, including preterm, low birth weight, PN history andothers.…”

Section: Discussionmentioning

confidence: 99%

“…The genetic disease, known as acrodermatitis enteropathica (AE, OMIM #201,100), is a rare autosomal recessive disease due to a mutation of the SLC39A4 gene (MIM #607,059), which encodes zinc/iron-regulated transporter-like protein 4 (ZIP4), leading to an impaired zinc absorption from the intestine [ 4 , 5 ]. Transient symptomatic zinc deficiency (TSZD), the most common type of acquired zinc deficiency in infants, usually occurs in preterm, low birth weight and exclusively breastfed infants because of their negative zinc balance secondary to inadequate stores and intakes, malabsorption, increased requirements and possible low zinc level in the mother’s milk [ 6 – 8 ]. The clinical manifestations are similar in both inherited and acquired zinc deficiency characterized by dermatitis, alopecia and diarrhoea [ 9 ], so the differentiation is a big challenge.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of similarities and differences between transient symptomatic zinc deficiency and acrodermatitis enteropathica in children: a case report of a Chinese Yi-ethnic infant

Gu,

He,

Zhu

2024

BMC Pediatr

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Background Transient symptomatic zinc deficiency (TSZD), an acquired type of zinc deficiency, is a rare, but probably underrecognized disease, extremely in breastfed premature with low birthweight infants. Its clinical manefestations are similar to Acrodermatitis enteropathica (AE), which is a genetic zinc absorption disorder caused by SLC39A4 gene mutations. This gene encodes a member of the zinc/iron-regulated transporter-like protein (ZIP) family. The encoded protein localizes to cell membranes and is required for zinc uptake in the intestine. TSZD is often misdiagnosed as AE because of their extremely similar manefestations, characterized by a typical rash. Therefore, the differention between them is still a clinical challenging. Case presentation Here, we present a case of TSZD in a 4 month and 23 days female Chinese Yi-ethnic premature with AE-like skin lesions, mainly presenting periorificial, perianal and perineal crusted, eroded, erythemato-squamous eruption. Laboratory examination showed the patient’s blood zinc level was significantly decreased. Further sequencing of the SLC39A4 gene showed no mutation in the infant and her parents. Skin lesions significantly improved after 6 days of initial zinc supplementation (3 mg/kg/d), and maintenance treatment with 1 mg/kg/day of zinc was discontinued after 8 months without recurrence. Conclusions The clinical manifestations of TSZD and AE are extremely similar, leading to a high rate of clinical misdiagnosis. While genetic analysis of the SLC39A4 gene is a reliable method for differentiating TSZD from AE. It is recommended that SLC39A4 gene test should be performed as far as possible in children with AE-like rash.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of similarities and differences between transient symptomatic zinc deficiency and acrodermatitis enteropathica in children: a case report of a Chinese Yi-ethnic infant

Gu,

He,

Zhu

2024

BMC Pediatr

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Transient Symptomatic Zinc Deficiency Resembling Acrodermatitis Enteropathica in a Full-Term Breastfed Infant

Yang

Pradhan

et al. 2020

Indian J Pediatr

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Transient symptomatic zinc deficiency in an exclusively breastfed infant

et al. 2021

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A 3-month-old, full term female infant, adequate for gestational age, and exclusively breastfed, was admitted with a 10 day history of generalised scaling erythematous dermatitis, affecting the face (perinasal, nasolabial folds and periauricular), acral and intertriginous areas, with irritability and failure to thrive. Her mother had been treated with isoniazid since the third trimester because of family contact with tuberculosis. Based on a diagnosis of suspected impetiginised eczema, the infant was treated with flucloxacillin and prednisolone, and maternal isoniazid was suspended, with no improvement. Investigations found low serum zinc levels in the infant (33 μg/dL; normal range (NR) >60 μg/dL), normal plasma zinc levels in the mother (111.3 μg/dL; NR 68–120 μg/dL) and lower than the normal range of zinc levels in breast milk (270μg/L; NR 1000–2500 μg/L), suggesting acrodermatitis caused by zinc deficiency. Oral zinc supplementation (3 mg/kg/day) was started with a marked improvement in skin lesions, as well as good weight gain. At the age of 6 months, after food diversification, supplementation was suspended, without any recurrence of symptoms.

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Transient symptomatic zinc deficiency in a breast‐fed African infant: case report and literature review

Abstract: A three-month-old African girl was born prematurely at 32 weeks' gestation. She presented a standard height-weight ª

Cited by 4 publications

References 10 publications

Analysis of similarities and differences between transient symptomatic zinc deficiency and acrodermatitis enteropathica in children: a case report of a Chinese Yi-ethnic infant

Analysis of similarities and differences between transient symptomatic zinc deficiency and acrodermatitis enteropathica in children: a case report of a Chinese Yi-ethnic infant

Transient Symptomatic Zinc Deficiency Resembling Acrodermatitis Enteropathica in a Full-Term Breastfed Infant

Transient symptomatic zinc deficiency in an exclusively breastfed infant

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