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Combined zinc and vitamin B6 deficiency in a patient with diffuse red rash and angular cheilitis 6 years after Roux-en-Y gastric bypass
  1. Jared Freitas,
  2. Patrick Bliven and
  3. Robert Case
  1. Department of Internal Medicine, School of Medicine, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Robert Case, racase42{at}


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.

  • nutrition
  • vitamins and supplements

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  • Contributors JF authored the primary version of the paper and performed a literature review to gather sources and confirm our findings. PB contributed edits to the primary version, participated in literature review and prepared the bibliography, reviewed the medical record and compiled clinical information relevant to the case. RC is the senior author who guided preparation of the initial draft, editing of the manuscript and then finalised the manuscript in the form which is being submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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