Case history
Case history #1
A 42-year-old woman with a 20-year history of Crohn's disease presents with low energy levels and hair loss. Her Crohn's disease is moderately well controlled, with episodic diarrhoea and abdominal pain, and has not required intestinal resection. The patient says that she does not feel like she is having a 'flare' of her Crohn's disease, and there are no rashes or other symptoms. On physical examination, her hair is mildly thin, and stomatitis is noted, but the physical examination is otherwise normal.
Case history #2
An 8-year-old boy from an underdeveloped rural community is seen by a health practitioner. He is noted to be below the fifth percentile for height, and has been doing poorly in school. On nutritional assessment‚ the boy's mother reports that his diet consists mainly of locally produced grains and vegetables that are not fortified, and that meats are rarely available. The mother also reports that he does not have much energy, but there are no other specific complaints and the physical exam is unremarkable. Review of the boy's growth chart shows that height had been stable at the thirtieth percentile until his last visit at the age of 4 years old.
Other presentations
The presentation of zinc deficiency is highly variable and there are no pathognomonic features. Growth and development features can include impairment of growth, hypogonadism, osteopenia, and weight loss. Neurological features can include intention tremor, depression, impaired concentration, nystagmus, dysarthria, night blindness, hypogeusia, and anosmia. Dermatological features can include alopecia, dermatitis, paronychia, and stomatitis. Gastrointestinal (GI) features can include anorexia, abdominal pain, diarrhoea, and glossitis. Other possible features include dementia, delayed wound healing, fever, pica, increased infections, blepharitis, impaired glucose tolerance, infertility, taste disorders, and adverse pregnancy outcomes.
Zinc deficiency is common in developing regions owing to malnutrition, while in developed regions zinc deficiency is associated with ageing and many chronic diseases. As zinc deficiency can present in many ways, it should be considered in people with at-risk conditions including: malabsorption syndrome, chronic GI (coeliac disease or Crohn's disease) and liver disease, renal disease, sickle cell disease, anorexia nervosa, and HIV infection.[2][3][4][6][7][8][9][10][11][12][13] People undergoing chronic treatment with certain medication (e.g., hydrochlorothiazide, penicillamine, ethambutol, certain antibiotics), people with alcohol use disorder, vegetarians, vegans, and infants with nutrient-poor diets are more prone to zinc deficiency.[1][5] Zinc deficiency in older people contributes to susceptibility to infection and osteoporosis.[14][15]
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