Sameera Shuaibi, MD, Samer Farhud, DO, Jeanne Nguyen, MD, Caley McIntyre, MD Ochsner Health System, Jefferson, LA
Introduction: Zinc deficiency can either be hereditary or acquired. It is often overlooked when diagnosis of skin rashes in acute hospital settings is required. Physicians tend to workup more common causes of rashes before coming to the conclusion of acrodematitis enteropathica (AE), a tender scaly rash, that can manifest also with bulla formation secondary to severe zinc deficiency. One important organ that plays a crucial role in zinc metabolism is the liver. Liver failure can interfere with zinc metabolism and manifest with its peculiar rash.
Case Description/Methods: 42 year old African American lady was admitted with decompensated alcoholic liver cirrhosis which was comprised of altered mental status and drowsiness along with diarrhea. Shortly after admission she developed a widespread rash that was painful, itchy, and scaly in nature with blisters. Different parts of the rash eventually began to peel/exfoliate. No unusual drugs were administered to her at that time that would have triggered an allergic reaction. After dermatology was consulted, extensive workup was undertaken and the lesions were biopsied. It was found to be acrodermatitis enteropathica. She was administered high doses of zinc on top of topical medications which helped improve the lesions with time.
Discussion: Liver disease can predispose to zinc deficiency in such that it hinders zinc metabolism. Zinc is an important nutrient that serves crucial roles in anti-oxidation, anti-inflammation, and proper integrity of the immune system and skin among other roles. The small intestine, pancreas, and liver play central roles in the maintenance of appropriate zinc levels in the body. Patients who develop liver disease may be a risk of experiencing sequelae of zinc deficiency such as AE. Alas, due to its sparsity physicians may not immediately opt for the diagnosis of AE even if the patient is suffering from end stage liver disease. Such cases are pivotal in increasing physician awareness of such conditions to avoid convoluted evaluations and loss of resources before reaching the diagnosis.
Figure: Desquamating Rash of Hands and Feet
Disclosures:
Sameera Shuaibi indicated no relevant financial relationships.
Samer Farhud indicated no relevant financial relationships.
Jeanne Nguyen indicated no relevant financial relationships.
Caley McIntyre indicated no relevant financial relationships.
Sameera Shuaibi, MD, Samer Farhud, DO, Jeanne Nguyen, MD, Caley McIntyre, MD. P4868 - Acrodermatitis Enteropathica in Liver Cirrhosis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
