Acrodermatitis enteropathica: recent findings concerning clinical features, pathogenesis, diagnosis and therapy

Acrodermatitis enteropathica (AE) was diagnosed in 2 siblings, boy and girl, at the age of 10 and 6 weeks. The family history is unremarkable except for consanguinity 5 generations previously. The clinical symptoms of the 2 patients conformed to the known features of AE, the gastrointestinal involvement loosing its significance with increasing age. In one patient in a stage of exacerbation the serum level of oleic acid (18:1) was lowered and of linoleic (18:2) acid slightly increased while that of arachidonic acid was decreased (Fig. 4). In both patients the serum zinc levels were significantly lowered. Under substitution with ZnSO4 the clinical condition improved and the serum zinc levels returned to normal. Histologically the small bowel mucosa was practically normal. Ultrastructural examination of jejunal biopsies revealed rather unspecific changes in the enterocytes in the form of numerous multivesicular bodies. The Paneth cells sometimes contained irregularly formed inhomogeneous structures within their cytoplasm. In addition the secretory granules varied in size and displayed a granular heteromorphic matrix. Frequently they were confluent and formed giant granules.

Acrodermatitis enteropathica associated with low density lipoproteins deficiency

This study describes clinical, biochemical, and histopathologic findings in a three-month-old infant with acrodermatitis enteropathica. Com plete absence of low density lipoprotein frac tions in serum was found on paper and cellogel electrophoresis. This is the first known patient with acrodermatitis enteropathica in whom a- beta-lipoproteinemia was diagnosed. Despite treatment with fluids, special diets, antibiotics and diiodoquine, the infant died after two months of hospitalization..

A marked reduction in the levels of pre-beta and beta-lipoproteins was also observed in the serum of a sister of the propositus, one month following birth, born after propositus' death. At present, the sister is six months old. During this period, a constant increase in the d < 1.063 lipoprotein fractions in the sister's serum was observed. The propositus and the entire family have been studied and results are presented.