A formerly premature, exclusively breast-fed infant with severe zinc d
eficiency syndrome is presented. He showed the characteristic erosive
skin changes, including alopecia, as seen in acrodermatitis enteropath
ica. In addition, he manifested a failure to thrive and irritability.
The diagnosis was confirmed by reduced serum levels of zinc (2.3 mu mo
l/l) and alkaline phosphatase (45 U/l). We consider the reduced zinc s
upply in the breast milk (5.7 mu mol/l) as the most likely cause of th
e disease. Therapy consisted of oral zinc supplements (50 mu mol/kg/da
y) for a period of 30 weeks. Symptoms and laboratory values normalized
completely and did not recur on a normal diet. Conclusion A diet of b
reast milk can, in rare circumstances, cause insufficient zinc intake
resulting in severe zinc deficiency syndrome with characteristic derma
tological features. Therapy consists of temporary oral zinc supplement
ation at a daily dose of 50 mu mol/kg.