Copper deficiency myeloneuropathy in a patient with Wilson disease

Abstract

Cases of copper deficiency myeloneuropathy (CDM) have been increasingly reported but hypocupremia remains to be an underrecognized cause of myelopathy.1 As zinc reduces copper gastrointestinal absorption, excess zinc ingestion is an important cause of hypocupremia.2 Wilson disease (WD) is a disorder of copper metabolism characterized by impaired excretion of this metal, resulting in its accumulation in many organs, such as liver, brain, and cornea. Treatment options include penicillamine, trientine, and zinc. We report the case of a patient with WD treated with zinc who developed a myeloneuropathy in the setting of copper deficiency. ### Case report. A previously healthy woman developed depression, postural tremor, and dysarthria at the age of 29 years. Based on the presence of Kayser-Fleischer rings and a low ceruloplasmin level (4 mg/dL, normal range 20–60), a diagnosis of WD was made. She received penicillamine for 1 year with resolution of symptoms and signs. Due to adverse event, this medication was switched to …