Freitas Jared, Bliven Patrick, Case Robert
Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA.
BMJ Case Rep. 2019 Aug 2;12(8):e230605. doi: 10.1136/bcr-2019-230605.
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.
一名39岁女性，有胃旁路手术（RYGB）史且饮酒，出现融合性红斑皮疹，累及会阴并向外蔓延至腹部、大腿和下背部。她有口角炎和舌炎。皮疹在散在区域有疼痛和水疱。就诊时她血压低，似乎处于感染性或低血容量性休克状态。血清锌和维生素B6水平极低，皮疹活检结果提示营养缺乏是其病因。在接下来的2周内，通过口服补充锌和维生素B6，皮疹逐渐好转。身体上的皮疹类似于因锌转运体遗传缺陷而出生的婴儿的皮疹，即肠病性肢端皮炎（AE）。该病例可能代表了在既往胃旁路手术背景下获得性的肠病性肢端皮炎病例。
