Abstract
IntroductionObesity is a risk factor for zinc deficiency. After bariatric surgery, non-compliance to diet/vitamin supplements, surgical complications leading to vomiting/diarrhea, poor follow-up and malabsorption can precipitate or exacerbate pre-existing zinc deficiency.Case reportWe report a patient with rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-en-Y gastric bypass (following primary laparoscopic sleeve gastrectomy).ConclusionBariatric teams should screen patients before bariatric surgery for nutritional deficiencies and continue surveillance of their nutritional status after surgery. They should maintain a high index of suspicion for zinc deficiency in patients with skin rash after bariatric surgery.Level of evidence Level V, case report.
Highlights
Obesity is a risk factor for zinc deficiency
We report a rare post-revisional RYGB Necrolytic migratory erythema (NME) due to severe zinc deficiency complicated by cellulitis and bacteremia
We report severe zinc deficiency after revisional bariatric surgery (BS) leading to rare cutaneous manifestations
Summary
Necrolytic migratory erythema (NME) is the most common cutaneous manifestation of glucagon-producing pancreatic neuro-endocrine tumors [1]. Investigations were done (Fig. 1i), she was assessed by the dermatology team, started on empirical treatment (IV dexamethasone), but with minimal improvement She underwent skin biopsy which suggested NME (Fig. 1j, Fig. 3), possibly due to abdominal neuro-endocrine tumor or severe zinc deficiency. Zinc deficiency was confirmed by the bariatric team and treatment (Fig. 1k) lead to drastic improvement of the skin rash with almost complete resolution on some areas about 2 weeks later, with residual hyperpigmentation (Fig. 2c, d). She received IV zinc in total parenteral nutrition (TPN) 7 mg/ day for 1 month duration. On the follow up visit, her symptoms resolved and she had normal blood results (Fig. 1m)
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