Combined zinc and vitamin B6 deficiency in a patient with diffuse red rash and angular cheilitis 6 years after Roux-en-Y gastric bypass

A 39-year-old woman with a history of Roux-en-Y gastric bypass (RYGB) surgery and alcohol use presented with a confluent erythematous rash involving the perineum spreading outward to the abdomen, thighs and lower back. She had angular cheilitis and glossitis. The rash was painful and blistering in s...

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Bibliographic Details
Published in:BMJ case reports 2019-08, Vol.12 (8), p.e230605
Main Authors: Freitas, Jared, Bliven, Patrick, Case, Robert
Format: Article
Language:English
Subjects:
Abdomen
Administration, Oral
Adult
Biopsy
Case reports
Cheilitis - etiology
Dermatology
Exanthema - etiology
Family medical history
Gastric Bypass - adverse effects
Gastrointestinal surgery
Heart surgery
Hepatitis
Hospitals
Humans
Infections
Infectious diseases
Literature reviews
Nutrition
Pain
Pathogens
Patients
Rare Disease
Skin
Treatment Outcome
Vitamin B 6 - administration & dosage
Vitamin B 6 - therapeutic use
Vitamin B 6 Deficiency - diagnosis
Vitamin B 6 Deficiency - drug therapy
Vitamin deficiency
Vitamins
Zinc - administration & dosage
Zinc - deficiency
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Summary:A 39-year-old woman with a history of Roux-en-Y gastric bypass (RYGB) surgery and alcohol use presented with a confluent erythematous rash involving the perineum spreading outward to the abdomen, thighs and lower back. She had angular cheilitis and glossitis. The rash was painful and blistering in scattered areas. She was hypotensive and appeared to be in septic or hypovolemic shock at presentation. Serum levels of zinc and vitamin B6 were critically low and biopsy of her rash returned suggestive of a nutritional deficiency as its source. The rash slowly improved over the following 2 weeks with oral zinc and vitamin B6 replacement. The body rash resembled that of infants born with inherited defects in zinc transporters, referred to as acrodermatitis enteropathica (AE). This case may represent an acquired case of AE in the setting of prior RYGB.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-230605