PMC8169277_01
Dermatological manifestations on admission showing (a) hair dyspigmentation and alopecia; (b) perioral dermatitis and glossitis; and (c), (d) bullae and erosions.
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The patient was also noted to have sparse hair with brownish discoloration (Figure 1).
Hematoxylin-and-eosin-stained skin biopsy showing (a) the epidermis and dermis; (b) acanthosis (yellow arrow); (c) parakeratosis (black arrow); and (d) neutrophilic epithelial infiltrate (blue arrow) and spongiosis (red arrow). (a) x100, (b) x200, and (c) and (d) x400 magnification.
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A skin biopsy of an intact lesion was performed, and it showed features consistent with AE including spongiosis with epidermal pallor, parakeratosis, and keratinocyte necrolysis (Figure 2).
Hematoxylin-and-eosin-stained ileal biopsy showing mild focal loss and blunting of the villi.
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Upper gastrointestinal endoscopy was performed and showed villous blunting, and biopsies of the duodenum and ilium were also performed and showed blunting of the villi (Figure 3).
Skin changes after zinc replacement with evident re-epithelialization after about a week of zinc supplementation.
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A few days after initiation of zinc, the patient showed remarkable improvement in the skin lesions including a reduction in the edema, resolution of diarrhea, and improvement in appetite (Figure 4).