A 62-year-old woman with heavy alcohol use developed difficulty walking and reduced oral intake over two weeks, followed by altered consciousness, disorientation, hallucinations, and watery diarrhea. She appeared cachectic. Erythema with erosions and fissures were observed on sun-exposed areas (Fig. 1A). Laboratory tests revealed hyponatremia (133 mEq/L), hypokalemia (2.8 mEq/L), macrocytic anemia (hemoglobin 7.1 g/dL; mean corpuscular volume 109 fL), hypoalbuminemia (2.5 g/dL), and low serum zinc (16 μg/dL; reference ≥80).
