Acrodermatitis enteropathica with a normal serum zinc level: a case report

Acrodermatitis enteropathica is a rare autosomal recessive disorder.The serum zinc levels are usually low in these patients‚ but cases with normal serum zinc level have been reported. The clinical manifestations include skin lesions‚ in particular in periorificial areas‚ and extremities ‚diarrhea and alopecia. These clinical signs may occur together only in 20% of the cases. Other manifestations of the disease are behavior and mood changes ‚failure to thrive‚ susceptibility to infection‚ nail changes and delayed wound healing. Case report: Here we report a case of acrodermatitis enteropathica with a normal serum zinc level. The patient was an 11 month old infant who was reffered to Bassat Hospital with well defined erythematous ‚erosions and crusted skin lesions in perioral‚ perianal ‚ buttocks‚ external genitalia and extremities from 4 months ago. The patient had history of irritability and infrequent episodes of diarrhea. Lab work up revealed a normal serum zinc level of 67µg/dl (Reference range: 60-121 µg/dl). 2 weeks after zinc supplementation‚ the skin lesions improved. Diagnosis of acrodermatitis enteropathica is based on clinical manifestations and this diagnosis is confirmed with a low serum zinc level. But in rare cases with normal serum zinc level and relevant clinical signs ‚we recommend a short term clinical trial of zinc supplementation. Improvement of the skin lesions and other symptoms confirms the diagnosis.