Track

Case Reports

Abstract

Zinc deficiency is often associated with various factors including poor socioeconomic status, dietary habits, infections, renal failure, pancreatic insufficiency, and malabsorptive syndromes. In some cases, it can lead to cutaneous manifestations in the form of acrodermatitis enteropathica, an inherited or acquired form of zinc deficiency. These manifestations typically include angular cheilitis, acral dermatitis, alopecia, nail dystrophy, and eczematous annular plaques, which may progress to vesicles, pustules, and bullae. 

In this report, we describe the case of a 39-year-old male with a history of developmental delay, zinc deficiency, sebopsoriasis, and bullous pemphigoid, who presented to the emergency room with a rash that had been present for four days and has been worsening. Upon physical examination, the patient demonstrated cheilitis, erythematous lips, and blistering lesions on various parts of his body, including the arms, central back, and genital area. This progressed into skin sloughing. The patient underwent a skin biopsy to rule out SJS/TEN. 

Histological examination revealed full-thickness epidermal necrosis with overlying orthokeratosis, upper epidermal pallor, and mild spongiosis. Immunofluorescence studies using antibodies for IgG, IgA, IgM, C3, and fibrinogen exhibited a negative or non-diagnostic staining pattern. A diagnosis of SJS/TEN was made. Although SJS/TEN is commonly linked to medications and infections, further clinical workup ruled out these etiologies. Notably, the patient's chronic zinc deficiency emerged as the sole contributing factor to this atypical presentation of TEN. Thus, we present a rare case of chronic zinc deficiency presenting as SJS/TEN.