case_images: PMC8169277_01
case_images: Dermatological manifestations on admission showing (a) hair dyspigmentation and alopecia; (b) perioral dermatitis and glossitis; and (c), (d) bullae and erosions.
case_images: CRIDM2021-5572583.001.jpg
case_images: PMC8169277_01_CRIDM2021-5572583.001.jpg
case_images: fig1
case_images: The patient was also noted to have sparse hair with brownish discoloration (Figure 1).
case_images: 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.
case_images: CRIDM2021-5572583.002.jpg
case_images: PMC8169277_01_CRIDM2021-5572583.002.jpg
case_images: fig2
case_images: 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).
case_images: Hematoxylin-and-eosin-stained ileal biopsy showing mild focal loss and blunting of the villi.
case_images: CRIDM2021-5572583.003.jpg
case_images: PMC8169277_01_CRIDM2021-5572583.003.jpg
case_images: fig3
case_images: 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).
case_images: Skin changes after zinc replacement with evident re-epithelialization after about a week of zinc supplementation.
case_images: CRIDM2021-5572583.004.jpg
case_images: PMC8169277_01_CRIDM2021-5572583.004.jpg
case_images: fig4
case_images: 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).