SHM Converge Scientific Abstract ePoster Gallery-This Rash Izn't Viral

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A 2-month-old former 31-week premature, exclusively breastfed male presented with 10 days of worsening erythematous, eroded, crusted papules and plaques involving the face, neck, genitalia, perianal area, and right upper extremity. He had irritability and diarrhea, and a prior diagnosis of impetigo did not improve with mupirocin, cephalexin, or cefazolin. Exam showed a striking periorificial and diaper-area distribution.<br /><br />Initial workup showed mild normocytic anemia, neutropenia, and mildly elevated CRP; metabolic testing and viral studies were largely negative. Because of concern for HSV or bacterial infection, acyclovir and antibiotics were briefly used, but dermatology evaluation and skin biopsy suggested zinc deficiency rather than infection. Empiric enteral zinc was started.<br /><br />The rash improved dramatically within 48 hours and resolved completely by 2 weeks. Subsequent testing confirmed low serum zinc, while vitamins A, B3, and D were normal. Vitamin B7 (biotin) was undetectable, but the rapid response to zinc and normal newborn screen made biotin deficiency less likely. Biopsy showed epidermal hyperplasia with pallor in the upper epidermis and parakeratosis, findings highly suggestive of acrodermatitis enteropathica (AE). Genetics sent testing for SLC39A4 and CFTR variants.<br /><br />This case highlights AE as an autosomal recessive zinc transporter disorder that can mimic infection. In infants with periorificial and diaper dermatitis, diarrhea, and poor response to antibiotics, zinc deficiency should be considered. Oral zinc replacement typically produces rapid improvement.

Asset Subtitle

Patrick M. O'Shea

Meta Tag

Author List Anna DePrenger, Brendan C. Lawson, Evans Lodge, Michael Contarino, Patrick M. O'Shea

Category Clinical Vignettes

Concept Acrodermatitis Enteropathica

Concept Zinc Supplementation

Concept Periorificial Dermatitis

Concept Acral Dermatitis

Concept Antibiotic Nonresponse

Distinguished Non-Finalist

Presenter Organization UNC School of Medicine

Presenting Author Patrick M. O'Shea

Track Pediatric

Keywords

acrodermatitis enteropathica

zinc deficiency

periorificial dermatitis

diaper dermatitis

premature infant

breastfed infant

skin biopsy

oral zinc replacement

diarrhea

SLC39A4 mutation

Acrodermatitis Enteropathica

Zinc Supplementation

Periorificial Dermatitis

Acral Dermatitis

Antibiotic Nonresponse