127 Hypocupraemia-induced anaemia, sensory ataxia and cognitive impairment secondary to zinc-containing dental adhesive

Abstract

A previously fit and well 67 year old male presented with a 5-month history of gradually worsening memory impairment and sensory gait ataxia on the background of recent symptomatic anaemia. He experienced multiple falls and became agitated and socially withdrawn over a 3-week period, resulting in hospital admission. On examination, he had sensory gait ataxia consistent with a dorsal column syndrome. He had a Montreal Cognitive Assessment score of 13. Serum analysis showed normocytic anaemia and leukopenia, severe hypocupraemia, reduced caeruloplasmin and normal zinc levels. Overuse of zinc- containing denture cream was identified as being a cause of excess zinc ingestion and resultant copper deficiency, leading to blood dyscrasia and myelopathy. The cream was withdrawn and IV copper followed by oral supplementation was implemented. Direct questions with regards to excess zinc in the diet and serological testing of copper and zinc should be considered in any patient with a dorsal column syndrome, particularly with concurrent anaemia. Copper deficiency may also have a role in exacerbat- ing pre-existing cognitive impairment.rnj1e16@soton.ac.uk