Zinc deficiency in an exclusively breast-fed preterm infant

Conclusion: A diet of breast milk can, in rare circumstances, cause insufficient zinc intake resulting in severe zinc deficiency syndrome with characteristic dermatological features. Therapy consists of temporary oral zinc supplementation at a daily dose of 50 μmol/kg. A formerly premature, exclusively breast-fed infant with severe zinc deficiency syndrome is presented. He showed the characteristic erosive skin changes, including alopecia, as seen in acrodermatitis enteropathica. In addition, he manifested a failure to thrive and irritability. The diagnosis was confirmed by reduced serum levels of zinc (2.3 μmol/l) and alkaline phosphatase (45 U/l). We consider the reduced zinc supply in the breast milk (5.7 μmol/l) as the most likely cause of the disease. Therapy consisted of oral zinc supplements (50 μmol/kg/day) for a period of 30 weeks. Symptoms and laboratory values normalized completely and did not recur on a normal diet.