Table 4 Case report timeline

T₀–4 months

Clinical presentation: dysgeusia, lower extremity edema, and cutaneous eruption and erythema of the lower extremities and acral region with desquamation

Management: refractory to topical triamcinolone 0.1% ointment

T₀–3 months

Clinical presentation: symptoms persisted with additional blurring of vision, xerostomia, diarrhea, hematochezia, anorexia, and thrombocytopenia

Diagnosis: immune thrombocytopenic purpura (ITP) and non-alcoholic steatohepatitis

Management: 22-day hospitalization, prednisone 60 mg and discharged with a 4-week taper

T₀–2 months

Clinical presentation: recurring edema in the lower extremities progressing rapidly to painful desquamative and vesiculobullous lesions

Diagnosis: eczematous dermatitis

Diagnostic tests: skin biopsy

Management: second hospitalization, discharged with another 4-week prednisone taper

Comments: developed sacral pressure ulcer

T₀

Clinical presentation: persistent edema, non-healing sacral ulcer, worsening desquamative plaques

Diagnosis: acquired acrodermatitis enteropathica and severe nutrition deficiency

Diagnostic tests: skin biopsy of the right medial malleolus, broad titre analyses, esophagogastroduodenoscopy and colonoscopy with biopsy

Management: broad nutrition repletion

T₀ + 3 weeks

Clinical presentation: marked improvements of cutaneous findings and gastrointestinal function

Diagnosis: adult autoimmune enteropathy

Management: discharged with central parenteral nutrition (CPN), prednisone 15 mg daily, and close outpatient follow-up

T₀ + 4 months

Clinical presentation: outpatient follow-up with unremarkable cutaneous findings

Management: continue CPN and oral supplements, close outpatient follow-up with gastroenterology and nutrition