成人获得性锌缺乏症1例

Acquired zinc deficiency in adults:a case report

报告1例成人获得性锌缺乏症。患者女,55岁,眼周及口周皮疹1个月,双手足水疱10余天。皮肤科检查:头发稀疏、颜色正常;双眼周、口周见红色斑疹、斑片及鳞屑;双手掌及手腕、双足底、足趾见红斑基础上水疱、大疱,疱壁厚,疱液澄清,尼氏征阴性,部分破溃结痂;肛周、骶尾部见多处破溃后红色糜烂面。腹部及四肢见散在红色斑疹、褐色痂皮,口腔及生殖器黏膜未累及。实验室检查:血清锌70.05μmol/L,碱性磷酸酶<20 U/L。皮损组织病理:轻度角化过度,表皮轻度增生,灶性细胞内细胞间水肿,局部形成小水疱,真皮浅中层血管周围少量淋巴细胞浸润。诊断:获得性锌缺乏症。治疗:予以口服葡萄糖酸锌溶液及营养支持疗法,皮损1周内缓解。随访3个月未见复发。

We report a case of acquired zinc deficiency in an adult patient.A 55-year-old woman presented with periocular and perioral rash for 1 month and blisters on both hands and feet for more than 10 days.Dermatological examination showed that her hair was sparse and normal in color.Red macules,patches and scales were observed around both eyes and mouth.Blisters and bullous blisters were observed on the basis of erythema of both palms and wrists,soles and toes.The herpes wall was thick,the herpes fluid was clear,the Nikolsky′s sign was negative,and some of the blisters were ulcerated and scabbed,red erosion surface after ulceration was observed in perianal and sacral tail.Scattered red macules and brown crusts were observed on the abdomen and extremities,but the oral and genital mucosa was not involved.Laboratory tests showed that serum zinc level was 70.05μmol/L and alkaline phosphatase level was less than 20 U/L.Histopathology of skin lesions showed mild hyperkeratosis and epidermal hyperplasia,intracellular and intercellular edema could be seen,small blister formation was observed locally,and a small amount of lymphocyte infiltration around vessels in the superficial and middle dermis.Acquired zinc deficiency was diagnosed.After treatment with zinc gluconate oral solution for one week,the patient′s skin lesions were significantly relieved.No recurrence was found during the 3-month follow-up.