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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Les&#245;es eritemato&#8208;descamativas na regi&#227;o perioral&#44; perinasal&#44; glabela e genital&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paciente do sexo masculino&#44; 5 meses de vida&#44; h&#225; dois meses com les&#245;es eritemato&#8208;descamativas inicialmente na regi&#227;o perioral que evolu&#237;ram para as regi&#245;es acral&#44; perinasal&#44; genital&#44; ombros e occipital com alopecia associada &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; O paciente n&#227;o apresentava diarreia nem comprometimento sist&#234;mico&#46; Foi tratado com antif&#250;ngico&#44; corticoide t&#243;pico e antibioticoterapia sist&#234;mica em outro servi&#231;o&#44; sem melhora&#46; Feita hip&#243;tese cl&#237;nica de acrodermatite enterop&#225;tica <span class="elsevierStyleItalic">versus</span> defici&#234;ncia neonatal transit&#243;ria de zinco &#40;DNTZ&#41;&#44; foram solicitadas dosagens de zinco e fosfatase alcalina&#44; cujos resultados n&#227;o apresentavam altera&#231;&#245;es&#46; Entre os antecedentes pessoais&#44; o paciente foi pr&#233;&#8208;termo &#40;34 semanas&#41;&#44; em aleitamento materno exclusivo&#46; A dosagem de zinco no leite materno n&#227;o pode ser realizada&#44; pois n&#227;o &#233; um teste comercialmente dispon&#237;vel no Brasil&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Diante do quadro cl&#237;nico caracter&#237;stico e pela extens&#227;o das les&#245;es cut&#226;neas&#44; foi iniciada suplementa&#231;&#227;o oral com zinco na dose de 3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;dia&#46; Ap&#243;s tr&#234;s semanas de suplementa&#231;&#227;o&#44; o paciente evoluiu com melhora significante &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#44; confirmando o diagn&#243;stico de defici&#234;ncia do mineral&#44; apesar da dosagem s&#233;rica de zinco normal&#46; O paciente continuou em acompanhamento&#59; com 1 ano e 3 meses de idade&#44; realizou o sequenciamento completo do exoma&#44; que identificou muta&#231;&#227;o no gene <span class="elsevierStyleItalic">SLC30A2</span>&#46; A genitora n&#227;o realizou o teste gen&#233;tico&#44; mas provavelmente o paciente herdou a muta&#231;&#227;o da m&#227;e&#44; que produzia leite com baixa concentra&#231;&#227;o de zinco&#46; Conclu&#237;mos tratar&#8208;se de DNTZ&#44; e foi suspensa a suplementa&#231;&#227;o&#46; O paciente evoluiu sem recidiva das les&#245;es&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">O zinco atua no desenvolvimento&#44; diferencia&#231;&#227;o e crescimento celular&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> A defici&#234;ncia desse mineral pode ter origem gen&#233;tica ou adquirida&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As formas gen&#233;ticas s&#227;o autoss&#244;micas recessivas&#44; conhecida classicamente como acrodermatite enterop&#225;tica&#44; ou autoss&#244;mica dominante&#44; chamada de DNTZ&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Na acrodermatite enterop&#225;tica&#44; a muta&#231;&#227;o ocorre no gene <span class="elsevierStyleItalic">SLC39A4</span>&#59; a incid&#234;ncia dessa muta&#231;&#227;o &#233; estimada em 1&#47;500&#46;000 crian&#231;as&#44; sem predile&#231;&#227;o por sexo ou etnia&#46; O gene <span class="elsevierStyleItalic">SLC39A4</span> codifica a prote&#237;na ZIP4&#44; presente nos enter&#243;citos do intestino e respons&#225;vel pela absor&#231;&#227;o do zinco&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> A DNTZ ocorre em crian&#231;as em aleitamento materno exclusivo&#44; em virtude da baixa concentra&#231;&#227;o de zinco no leite&#44; decorrente da muta&#231;&#227;o materna no gene <span class="elsevierStyleItalic">SLC30A2</span>&#46; Esse gene codifica um transportador de zinco chamado ZNT2&#44; presente nas c&#233;lulas das gl&#226;ndulas mam&#225;rias e respons&#225;vel por transportar o mineral para o leite materno&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta as principais diferen&#231;as entre a acrodermatite enterop&#225;tica e a DNTZ&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">As formas adquiridas de defici&#234;ncia de zinco podem ser por prematuridade&#44; nutri&#231;&#227;o parenteral deficit&#225;ria em zinco e s&#237;ndromes de m&#225; absor&#231;&#227;o intestinal&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">O quadro cl&#237;nico das formas gen&#233;ticas e adquirida s&#227;o semelhantes&#46; Em ambas&#44; os pacientes apresentam placas eritemato&#8208;descamativas&#44; podendo surgir ves&#237;culas&#44; bolhas e p&#250;stulas nas regi&#245;es periorificiais e acral&#46; Outras manifesta&#231;&#245;es presentes s&#227;o alopecia&#44; diarreia&#44; queilite angular&#44; paron&#237;quia&#44; retardo de crescimento&#44; d&#233;ficit neurol&#243;gico&#44; dificuldade de cicatriza&#231;&#227;o&#44; anemia&#44; fotofobia&#44; hipogeusia&#44; anorexia&#44; atraso puberal e hipogonadismo&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;5</span></a> Os sintomas da acrodermatite enterop&#225;tica cl&#225;ssica costumam surgir quando o aleitamento materno &#233; interrompido&#44; pois o leite materno &#233; rico em zinco biodispon&#237;vel&#59; entretanto&#44; em beb&#234;s prematuros com alta demanda de zinco&#44; os sintomas podem surgir durante a amamenta&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Entre os diagn&#243;sticos diferenciais&#44; devemos considerar defici&#234;ncia de biotina&#44; infec&#231;&#245;es f&#250;ngicas&#44; dermatite seborreica&#44; psor&#237;ase&#44; histiocitose de c&#233;lulas de Langerhans e dermatite de contato&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">O presente caso foi um desafio diagn&#243;stico&#44; pois a dosagem s&#233;rica de zinco estava normal&#46; No entanto&#44; de acordo com a literatura&#44; h&#225; relatos de acrodermatite enterop&#225;tica com dosagem s&#233;rica de zinco normal&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#8211;9</span></a> Esse paradoxo &#233;&#44; em parte&#44; resultado da homeostase do zinco plasm&#225;tico&#44; que compreende apenas 0&#44;1&#37; das reservas totais de zinco corporal&#46; Portanto&#44; medir com precis&#227;o o <span class="elsevierStyleItalic">status</span> de zinco no organismo &#233; dif&#237;cil&#46; N&#237;vel s&#233;rico reduzido de fosfatase alcalina&#44; uma metaloenzima dependente do zinco&#44; pode auxiliar no diagn&#243;stico&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Com tratamento adequado&#44; as altera&#231;&#245;es decorrentes da defici&#234;ncia de zinco regridem sem sequelas&#59; por&#233;m&#44; per&#237;odos prolongados de car&#234;ncia podem afetar permanentemente o crescimento e desenvolvimento neurol&#243;gico do paciente&#46; A suplementa&#231;&#227;o de zinco em crian&#231;as com defici&#234;ncia transit&#243;ria deve ser realizada com 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;dia&#44; e pacientes com acrodermatite enterop&#225;tica devem receber 3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;dia de suplementa&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Na acrodermatite enterop&#225;tica&#44; a suplementa&#231;&#227;o deve ser mantida pelo resto da vida&#59; j&#225; na DNTZ&#44; a suplementa&#231;&#227;o pode ser suspensa ap&#243;s o per&#237;odo de aleitamento materno exclusivo&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Este relato de caso mostra a import&#226;ncia do teste gen&#233;tico no diagn&#243;stico da defici&#234;ncia de zinco em lactentes&#44; uma vez que&#44; independente da etiologia&#44; as manifesta&#231;&#245;es cl&#237;nicas podem ser id&#234;nticas&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0060" class="elsevierStylePara elsevierViewall">Luciane Francisca Fernandes Botelho&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; levantamento dos dados&#44; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Selma H&#233;l&#232;ne&#58; An&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta propede&#770;utica e terape&#770;utica do caso estudado&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Carolina Gon&#231;alves Contin Proen&#231;a&#58; Participa&#231;&#227;o intelectual em conduta propede&#770;utica e terape&#770;utica do caso estudado&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Silvia Assump&#231;&#227;o Soutto Mayor&#58; Concep&#231;&#227;o e planejamento do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e terap&#234;utica do caso estudado&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Botelho LFF&#44; H&#233;l&#232;ne S&#44; Proen&#231;a CGC&#44; Mayor SAS&#46; Transient neonatal zinc deficiency or acrodermatitis enteropathica&#63; An Bras Dermatol&#46; 2024&#59;99&#58;763&#8211;5&#46;</p>"
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          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Tr&#234;s semanas ap&#243;s a suplementa&#231;&#227;o de zinco&#44; o paciente evoluiu com melhora significante&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Defici&#234;ncia neonatal transit&#243;ria de zinco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Acrodermatite enterop&#225;tica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Muta&#231;&#227;o gen&#233;tica e heran&#231;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">SLC30A2</span>&#44; autoss&#244;mica dominante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">SLC39A4</span>&#44; autoss&#244;mica recessiva&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Momento da apresenta&#231;&#227;o cl&#237;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ocorre nos primeiros meses de vida na vig&#234;ncia de aleitamento materno exclusivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ocorre geralmente ap&#243;s suspens&#227;o do aleitamento materno&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Dosagem s&#233;rica de zinco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Reduzida&#44; raramente normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Reduzida&#44; raramente normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Dosagem de zinco no leite materno&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Reduzida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Dosagem s&#233;rica de zinco materno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Necessidade de suplementa&#231;&#227;o de zinco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Somente durante o aleitamento materno exclusivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Durante toda vida&nbsp;\t\t\t\t\t\t\n
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                      "Revista" => array:5 [
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Cartas ‐ Caso clínico
Deficiência neonatal transitória de zinco ou acrodermatite enteropática?
Luciane Francisca Fernandes Botelho
Corresponding author
lucianebotelho@hotmail.com

Autor para correspondência.
, Selma Hélène, Carolina Gonçalves Contin Proença, Silvia Assumpção Soutto Mayor
Clínica de Dermatologia, Hospital da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paciente do sexo masculino&#44; 5 meses de vida&#44; h&#225; dois meses com les&#245;es eritemato&#8208;descamativas inicialmente na regi&#227;o perioral que evolu&#237;ram para as regi&#245;es acral&#44; perinasal&#44; genital&#44; ombros e occipital com alopecia associada &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; O paciente n&#227;o apresentava diarreia nem comprometimento sist&#234;mico&#46; Foi tratado com antif&#250;ngico&#44; corticoide t&#243;pico e antibioticoterapia sist&#234;mica em outro servi&#231;o&#44; sem melhora&#46; Feita hip&#243;tese cl&#237;nica de acrodermatite enterop&#225;tica <span class="elsevierStyleItalic">versus</span> defici&#234;ncia neonatal transit&#243;ria de zinco &#40;DNTZ&#41;&#44; foram solicitadas dosagens de zinco e fosfatase alcalina&#44; cujos resultados n&#227;o apresentavam altera&#231;&#245;es&#46; Entre os antecedentes pessoais&#44; o paciente foi pr&#233;&#8208;termo &#40;34 semanas&#41;&#44; em aleitamento materno exclusivo&#46; A dosagem de zinco no leite materno n&#227;o pode ser realizada&#44; pois n&#227;o &#233; um teste comercialmente dispon&#237;vel no Brasil&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Diante do quadro cl&#237;nico caracter&#237;stico e pela extens&#227;o das les&#245;es cut&#226;neas&#44; foi iniciada suplementa&#231;&#227;o oral com zinco na dose de 3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;dia&#46; Ap&#243;s tr&#234;s semanas de suplementa&#231;&#227;o&#44; o paciente evoluiu com melhora significante &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#44; confirmando o diagn&#243;stico de defici&#234;ncia do mineral&#44; apesar da dosagem s&#233;rica de zinco normal&#46; O paciente continuou em acompanhamento&#59; com 1 ano e 3 meses de idade&#44; realizou o sequenciamento completo do exoma&#44; que identificou muta&#231;&#227;o no gene <span class="elsevierStyleItalic">SLC30A2</span>&#46; A genitora n&#227;o realizou o teste gen&#233;tico&#44; mas provavelmente o paciente herdou a muta&#231;&#227;o da m&#227;e&#44; que produzia leite com baixa concentra&#231;&#227;o de zinco&#46; Conclu&#237;mos tratar&#8208;se de DNTZ&#44; e foi suspensa a suplementa&#231;&#227;o&#46; O paciente evoluiu sem recidiva das les&#245;es&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">O zinco atua no desenvolvimento&#44; diferencia&#231;&#227;o e crescimento celular&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> A defici&#234;ncia desse mineral pode ter origem gen&#233;tica ou adquirida&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As formas gen&#233;ticas s&#227;o autoss&#244;micas recessivas&#44; conhecida classicamente como acrodermatite enterop&#225;tica&#44; ou autoss&#244;mica dominante&#44; chamada de DNTZ&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Na acrodermatite enterop&#225;tica&#44; a muta&#231;&#227;o ocorre no gene <span class="elsevierStyleItalic">SLC39A4</span>&#59; a incid&#234;ncia dessa muta&#231;&#227;o &#233; estimada em 1&#47;500&#46;000 crian&#231;as&#44; sem predile&#231;&#227;o por sexo ou etnia&#46; O gene <span class="elsevierStyleItalic">SLC39A4</span> codifica a prote&#237;na ZIP4&#44; presente nos enter&#243;citos do intestino e respons&#225;vel pela absor&#231;&#227;o do zinco&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> A DNTZ ocorre em crian&#231;as em aleitamento materno exclusivo&#44; em virtude da baixa concentra&#231;&#227;o de zinco no leite&#44; decorrente da muta&#231;&#227;o materna no gene <span class="elsevierStyleItalic">SLC30A2</span>&#46; Esse gene codifica um transportador de zinco chamado ZNT2&#44; presente nas c&#233;lulas das gl&#226;ndulas mam&#225;rias e respons&#225;vel por transportar o mineral para o leite materno&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta as principais diferen&#231;as entre a acrodermatite enterop&#225;tica e a DNTZ&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">As formas adquiridas de defici&#234;ncia de zinco podem ser por prematuridade&#44; nutri&#231;&#227;o parenteral deficit&#225;ria em zinco e s&#237;ndromes de m&#225; absor&#231;&#227;o intestinal&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">O quadro cl&#237;nico das formas gen&#233;ticas e adquirida s&#227;o semelhantes&#46; Em ambas&#44; os pacientes apresentam placas eritemato&#8208;descamativas&#44; podendo surgir ves&#237;culas&#44; bolhas e p&#250;stulas nas regi&#245;es periorificiais e acral&#46; Outras manifesta&#231;&#245;es presentes s&#227;o alopecia&#44; diarreia&#44; queilite angular&#44; paron&#237;quia&#44; retardo de crescimento&#44; d&#233;ficit neurol&#243;gico&#44; dificuldade de cicatriza&#231;&#227;o&#44; anemia&#44; fotofobia&#44; hipogeusia&#44; anorexia&#44; atraso puberal e hipogonadismo&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;5</span></a> Os sintomas da acrodermatite enterop&#225;tica cl&#225;ssica costumam surgir quando o aleitamento materno &#233; interrompido&#44; pois o leite materno &#233; rico em zinco biodispon&#237;vel&#59; entretanto&#44; em beb&#234;s prematuros com alta demanda de zinco&#44; os sintomas podem surgir durante a amamenta&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Entre os diagn&#243;sticos diferenciais&#44; devemos considerar defici&#234;ncia de biotina&#44; infec&#231;&#245;es f&#250;ngicas&#44; dermatite seborreica&#44; psor&#237;ase&#44; histiocitose de c&#233;lulas de Langerhans e dermatite de contato&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">O presente caso foi um desafio diagn&#243;stico&#44; pois a dosagem s&#233;rica de zinco estava normal&#46; No entanto&#44; de acordo com a literatura&#44; h&#225; relatos de acrodermatite enterop&#225;tica com dosagem s&#233;rica de zinco normal&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#8211;9</span></a> Esse paradoxo &#233;&#44; em parte&#44; resultado da homeostase do zinco plasm&#225;tico&#44; que compreende apenas 0&#44;1&#37; das reservas totais de zinco corporal&#46; Portanto&#44; medir com precis&#227;o o <span class="elsevierStyleItalic">status</span> de zinco no organismo &#233; dif&#237;cil&#46; N&#237;vel s&#233;rico reduzido de fosfatase alcalina&#44; uma metaloenzima dependente do zinco&#44; pode auxiliar no diagn&#243;stico&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Com tratamento adequado&#44; as altera&#231;&#245;es decorrentes da defici&#234;ncia de zinco regridem sem sequelas&#59; por&#233;m&#44; per&#237;odos prolongados de car&#234;ncia podem afetar permanentemente o crescimento e desenvolvimento neurol&#243;gico do paciente&#46; A suplementa&#231;&#227;o de zinco em crian&#231;as com defici&#234;ncia transit&#243;ria deve ser realizada com 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;dia&#44; e pacientes com acrodermatite enterop&#225;tica devem receber 3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;dia de suplementa&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Na acrodermatite enterop&#225;tica&#44; a suplementa&#231;&#227;o deve ser mantida pelo resto da vida&#59; j&#225; na DNTZ&#44; a suplementa&#231;&#227;o pode ser suspensa ap&#243;s o per&#237;odo de aleitamento materno exclusivo&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Este relato de caso mostra a import&#226;ncia do teste gen&#233;tico no diagn&#243;stico da defici&#234;ncia de zinco em lactentes&#44; uma vez que&#44; independente da etiologia&#44; as manifesta&#231;&#245;es cl&#237;nicas podem ser id&#234;nticas&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0060" class="elsevierStylePara elsevierViewall">Luciane Francisca Fernandes Botelho&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; levantamento dos dados&#44; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Selma H&#233;l&#232;ne&#58; An&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta propede&#770;utica e terape&#770;utica do caso estudado&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Carolina Gon&#231;alves Contin Proen&#231;a&#58; Participa&#231;&#227;o intelectual em conduta propede&#770;utica e terape&#770;utica do caso estudado&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Silvia Assump&#231;&#227;o Soutto Mayor&#58; Concep&#231;&#227;o e planejamento do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e terap&#234;utica do caso estudado&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Botelho LFF&#44; H&#233;l&#232;ne S&#44; Proen&#231;a CGC&#44; Mayor SAS&#46; Transient neonatal zinc deficiency or acrodermatitis enteropathica&#63; An Bras Dermatol&#46; 2024&#59;99&#58;763&#8211;5&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Hospital da Santa Casa de Miseric&#243;rdia de S&#227;o Paulo&#44; S&#227;o Paulo&#44; SP&#44; Brasil&#46;</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Les&#245;es eritemato&#8208;descamativas na regi&#227;o perioral&#44; perinasal&#44; glabela e genital&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Defici&#234;ncia neonatal transit&#243;ria de zinco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Acrodermatite enterop&#225;tica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Muta&#231;&#227;o gen&#233;tica e heran&#231;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">SLC30A2</span>&#44; autoss&#244;mica dominante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">SLC39A4</span>&#44; autoss&#244;mica recessiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Momento da apresenta&#231;&#227;o cl&#237;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ocorre nos primeiros meses de vida na vig&#234;ncia de aleitamento materno exclusivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ocorre geralmente ap&#243;s suspens&#227;o do aleitamento materno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Dosagem s&#233;rica de zinco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Reduzida&#44; raramente normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reduzida&#44; raramente normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dosagem de zinco no leite materno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Reduzida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dosagem s&#233;rica de zinco materno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Necessidade de suplementa&#231;&#227;o de zinco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Durante toda vida&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas da defici&#234;ncia neonatal transit&#243;ria de zinco e acrodermatite enterop&#225;tica</p>"
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                    0 => array:2 [
                      "titulo" => "Zinc and skin disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Ogawa"
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Article information
ISSN: 26662752
Original language: Portuguese
DOI:10.1016/j.abdp.2024.05.026
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