Acquired Acrodermatitis Enteropathica
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《新英格兰医药杂志》
A 41-year-old woman with a history of alcohol abuse, hypertension, and type 1 diabetes mellitus complicated by retinopathy, nephropathy, and end-stage renal disease presented with a five-month history of alopecia and fine, brittle scalp hair, diarrhea, angular cheilitis, and a pruritic, scaly erythematous eruption (Panel A) that preferentially involved the distal extremities, the perineum (Panel B), and the buttocks. The patient did not have any neurologic symptoms. The skin eruption was treated unsuccessfully with topical corticosteroids and antifungal agents and with oral antibiotics. A skin-biopsy specimen from the left inner thigh revealed confluent parakeratosis with an absence of the granular layer and occasional vacuolated cells in a minimally acanthotic epidermis. Late acquired acrodermatitis enteropathica was diagnosed and confirmed by the finding of serum zinc levels that were markedly reduced, at 0.35 μg per milliliter (5.4 μmol per liter; normal range, 0.66 to 1.10 μg per milliliter [10.1 to 16.8 μmol per liter]). Oral zinc sulfate supplementation was started, and within the first few weeks the patient's diarrhea resolved, her hair began to regrow, and her skin eruption cleared.
Linda C. Wang, M.D., J.D.
Brigham and Women's Hospital
Boston, MA 02115
Shail Bushey, M.D.
University of Chicago
Chicago, IL 60637
Linda C. Wang, M.D., J.D.
Brigham and Women's Hospital
Boston, MA 02115
Shail Bushey, M.D.
University of Chicago
Chicago, IL 60637