Acrodermatitis Due to Zinc Deficiency After Combined Vertical Gastroplasty with Jejunoileal Bypass: Case Report

Overview

Journal Sao Paulo Med J

Specialty General Medicine

Date 2012 Nov 24

PMID 23174873

Citations 5

Authors

Selma Freire de Carvalho Cunha

Gilson Antonio Pereira Goncalves

Julio Sergio Marchini

Ana Maria Ferreira Roselino

Affiliations

Soon will be listed here.

Abstract

Context: Nutritional complications may occur after bariatric surgery, due to restriction of food intake and impaired digestion or absorption of nutrients.

Case Report: After undergoing vertical gastroplasty and jejunoileal bypass, a female patient presented marked weight loss and protein deficiency. Seven months after the bariatric surgery, she presented dermatological features compatible with acrodermatitis enteropathica, as seen from the plasma zinc levels, which were below the reference values (34.4 mg%). The skin lesions improved significantly after 1,000 mg/day of zinc sulfate supplementation for one week.

Conclusions: The patient's evolution shows that the multidisciplinary team involved in surgical treatment of obesity should take nutritional deficiencies into consideration in the differential diagnosis of skin diseases, in order to institute early treatment.

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References

Parkes E . Nutritional management of patients after bariatric surgery. Am J Med Sci. 2006; 331(4):207-13. DOI: 10.1097/00000441-200604000-00007. View

Cousins R . Metal elements and gene expression. Annu Rev Nutr. 1994; 14:449-69. DOI: 10.1146/annurev.nu.14.070194.002313. View

Kiilerich S, Hey N, Naestoft J, Christiansen C . Hypozincaemia after jejuno-ileal bypass. Scand J Gastroenterol. 1979; 14(7):781-3. DOI: 10.3109/00365527909181404. View

Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R . Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)-a prospective study. Obes Surg. 2010; 20(4):447-53. DOI: 10.1007/s11695-009-0068-4. View

Griffith D, Liff D, Ziegler T, Esper G, Winton E . Acquired copper deficiency: a potentially serious and preventable complication following gastric bypass surgery. Obesity (Silver Spring). 2009; 17(4):827-31. PMC: 2712481. DOI: 10.1038/oby.2008.614. View

Di Martino G, Matera M, De Martino B, Vacca C, Di Martino S, Rossi F . Relationship between zinc and obesity. J Med. 1993; 24(2-3):177-83. View

Kushner R . Managing the obese patient after bariatric surgery: a case report of severe malnutrition and review of the literature. JPEN J Parenter Enteral Nutr. 2000; 24(2):126-32. DOI: 10.1177/0148607100024002126. View

Garb J, Welch G, Zagarins S, Kuhn J, Romanelli J . Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg. 2009; 19(10):1447-55. DOI: 10.1007/s11695-009-9927-2. View

Powell S . The antioxidant properties of zinc. J Nutr. 2000; 130(5S Suppl):1447S-54S. DOI: 10.1093/jn/130.5.1447S. View

10.

Lewandowski H, Breen T, Huang E . Kwashiorkor and an acrodermatitis enteropathica-like eruption after a distal gastric bypass surgical procedure. Endocr Pract. 2007; 13(3):277-82. DOI: 10.4158/EP.13.3.277. View

11.

Shankar P, Boylan M, Sriram K . Micronutrient deficiencies after bariatric surgery. Nutrition. 2010; 26(11-12):1031-7. DOI: 10.1016/j.nut.2009.12.003. View

12.

Olin K, Golub M, Gershwin M, Hendrickx A, Lonnerdal B, Keen C . Extracellular superoxide dismutase activity is affected by dietary zinc intake in nonhuman primate and rodent models. Am J Clin Nutr. 1995; 61(6):1263-7. DOI: 10.1093/ajcn/61.6.1263. View

13.

Slater G, Ren C, Siegel N, Williams T, Barr D, Wolfe B . Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004; 8(1):48-55. DOI: 10.1016/j.gassur.2003.09.020. View

14.

Pires L, Martins L, Geloneze B, Tambascia M, do Monte S, do Nascimento Nogueira N . The effect of Roux-en-Y gastric bypass on zinc nutritional status. Obes Surg. 2007; 17(5):617-21. DOI: 10.1007/s11695-007-9105-3. View

15.

Prodan C, Bottomley S, Vincent A, Cowan L, Greenwood-Van Meerveld B, Holland N . Copper deficiency after gastric surgery: a reason for caution. Am J Med Sci. 2009; 337(4):256-8. DOI: 10.1097/MAJ.0b013e31818ad0ff. View

16.

Prasad A . Zinc: an overview. Nutrition. 1995; 11(1 Suppl):93-9. View

17.

Maverakis E, Fung M, Lynch P, Draznin M, Michael D, Ruben B . Acrodermatitis enteropathica and an overview of zinc metabolism. J Am Acad Dermatol. 2006; 56(1):116-24. DOI: 10.1016/j.jaad.2006.08.015. View

18.

Cominetti C, Garrido Jr A, Cozzolino S . Zinc nutritional status of morbidly obese patients before and after Roux-en-Y gastric bypass: a preliminary report. Obes Surg. 2006; 16(4):448-53. DOI: 10.1381/096089206776327305. View

19.

Stocker D . Management of the bariatric surgery patient. Endocrinol Metab Clin North Am. 2003; 32(2):437-57. DOI: 10.1016/s0889-8529(03)00002-1. View

20.

Hambidge K, Miller L, Westcott J, Sheng X, Krebs N . Zinc bioavailability and homeostasis. Am J Clin Nutr. 2010; 91(5):1478S-1483S. PMC: 2854914. DOI: 10.3945/ajcn.2010.28674I. View