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A 3 month old girl presented with a striking erythematous rash on her lower limbs. She had become increasingly oedematous and had started to vomit frequently. Despite being breast fed, her stools were frequent, offensive, and pale. Investigations revealed anaemia, hypoproteinaemia, and deranged liver function. Serum zinc levels were normal.
This is necrolytic migratory erythema. In children, it may occur in association with liver disease, inflammatory bowel disease, pancreatitis, and malabsorption syndromes. A deficiency of amino acids, essential fatty acids, and/or zinc is thought to be the cause. Our child was subsequently found to have cystic fibrosis. Creon (pancreatic enzymes) and Ketovite (multivitamins and folic acid) supplementation resulted in a dramatic resolution of the rash and a sustained improvement in the child’s condition.
Competing interests: none