Zinc deficiency manifested by dermatitis and visual dysfunction in a patient with Crohn's disease

Abstract

We report a case of Crohn's disease with low serum zinc concentration in a 26-year-old woman. She demonstrated acrodermatitis enteropathica and decreased visual acuity during total parenteral nutrition. Subsequent intravenous zinc supplementation resulted in alleviation of the skin lesions and improvement of visual acuity. This case supports the notion that depressed serum zinc in Crohn's disease may cause clinical manifestations, such as acrodermatitis enteropathica and retinal dysfunction, which may be correctable with zinc supplementation.

Optic Nerve Changes in Zinc-deficient Rats

“…Copper and manganese have been proved by authors to be essential for optic nerve ®bers (Mishima et al, 1996;Gong and Amemiya, 1999). Zn is also thought to be essential for the optic nerve, because papillitis, optic nerve atrophy and optic neuropathy occur under Znde®cient conditions (Sturtevant, 1980;Yolton, 1981), such as chronic alcoholism (Prasad, 1985;Akar and Arcasoy, 1990;Vannucchi et al, 1995), liver cirrhosis (Scholmerich et al, 1983;Ozsoylu et al, 1991), Crohn's disease (Heimburger, Tamura and Marks, 1990;Myung et al, 1998) and acrodermatitis enteropathia (Chesters, 1997;Muga and Grider, 1999) and with the administration of drugs such as ethambutol (Yolton, 1981), disul®ram and penicillamine (Klingberg, Prasad and Oberleas, 1976;Weismann, 1986). However, optic nerves probably damaged under Zn-de®cient conditions have not been examined histopathologically.…”

Nutritional Deficiencies in Morbidly Obese Patients: A New Form of Malnutrition?

“…Other rich food sources include fortified breakfast cereals, beans, nuts, certain seafood, whole grains, and dairy products [52]. The bioavailability of zinc from the diet depends on various factors [1,48,49]. Phytates, which are phosphorus compounds found primarily in cereal grains, legumes, and nuts, can bind with minerals such as zinc, iron, and calcium, and decrease their absorption [53,54].…”

“…Zinc is also important for immunological reactions, wound healing, and preservation of the integrity of epithelial surfaces. Deficiencies are often seen in patients with malabsorption disorders such as Crohn's disease and in patients who are on prolonged total parenteral nutrition [48,49]. Urinary zinc excretion is markedly elevated after trauma or surgery, but the exact mechanism for its deficiency in these patients is poorly understood [50,51].…”

Iron Deficiency, Zinc, Magnesium, Vitamin Deficiencies in Crohn's Disease: Substitute or Not?

“…2 ) some- 108 times also combined with decreased visual acuity. Intravenous (in severe cases) or oral substitution of zinc restitutes normality [15] . A standard western diet contains enough trace elements to maintain zinc homeostasis.…”