25410883 Visualization

A 77 Age - year Age - old Age woman Sex with dysphagia Sign_symptom presented Clinical_event with a two Duration - week Duration history Duration of rash Sign_symptom characterized by brown Color plaques Sign_symptom with erythematous Detailed_description borders Detailed_description and overlying Detailed_description thick Detailed_description scales Detailed_description involving the face Biological_structure and a prior percutaneous Diagnostic_procedure endoscopic Diagnostic_procedure gastrostomy Diagnostic_procedure ( PEG Diagnostic_procedure ) tube site Biological_structure (Fig.1a, c).
No oral Biological_structure or conjunctival Biological_structure involvement Sign_symptom was present.
She had been receiving parenteral Medication nutrition Medication for two Duration months Duration following removal of the PEG Diagnostic_procedure tube Diagnostic_procedure due to infection Disease_disorder .
Although the differential diagnosis included drug Disease_disorder hypersensitivity Disease_disorder , autoimmune Disease_disorder disorders Disease_disorder and nutritional Disease_disorder deficiency Disease_disorder , the rash Sign_symptom appearance was most consistent with acrodermatitis Disease_disorder enteropathica Disease_disorder -like eruption Sign_symptom secondary to zinc Disease_disorder deficiency Disease_disorder .
Her serum Detailed_description zinc Diagnostic_procedure level was 12 Lab_value mcg/dL Lab_value (normal, 55–150 mcg/dL), and the rash Sign_symptom resolved within Date one Date week Date of parenteral Administration zinc Medication supplementation Medication (Fig.1b, d).
Zinc is essential for protein synthesis and wound healing.
Acrodermatitis enteropathica presents in infancy as a periorificial desquamative dermatitis, resulting from an autosomal recessive mutation that impairs zinc absorption. A similar syndrome may occur due to nutritional zinc deficiency, and has been reported in the setting of parenteral nutrition that fails to include zinc supplementation; a prompt response to supplementation helps to confirm the diagnosis.
A recent national shortage of parenteral zinc in the United States likely contributed to this patient’s presentation.