Copper Deficiency Myeloneuropathy with Hypozincemia Due to Zinc Excess, Gastrectomy, and Low Serum Ceruloplasmin (P03.191)

Abstract

Objective: We describe low serum zinc level in copper deficiency myeloneuropathy (CuDM) associated with excess zinc ingestion and prior gastrectomy. Background The malabsorption of copper occurs after gastrectomy or bariatric surgeries and can cause CuDM. The antagonistic relationship between copper and zinc is the basis for treatment of states of copper excess (e.g. Wilson9s disease) with zinc supplementation. Zinc excess due to long term denture cream usage can be the cause of CuDM. Design/Methods: Case Report: An 83 year old man developed progressive triple flexor spasms, severe sensory loss, and absent/diminished reflexes with Babinski signs over 5 years following gastrectomy 38 years previously, using zinc-based denture cream (three tubes weekly) for 30 years, and having hypoceruloplasminemia. Serum copper was 0.12 µg/mL (RI 0.75-1.45mcg/mL), ceruloplasmin 4.0 mg/dL (RI 15-30mg/dL), and serum zinc 0.58 µg/mL (RI 0.66-1.0mcg/mL). Results: Our patient had three causes for CuDM—hypocupremia, excess intake of zinc, and hypoceruloplasminemia. Patients with CuDM due to excess zinc ingestion may have normal to elevated serum zinc levels (Nations 2008). Hypozincemia was noted by Kumar, et al (Kumar 2004) in a patient following gastrectomy and poor copper absorption. Gastrectomy will, in addition to decreasing serum copper levels, also decrease serum zinc. Our patient demonstrated low serum zinc levels in the face of excess zinc ingestion and was likely the result of his prior gastrectomy. Conclusions: Excess ingestion of zinc interferes with the absorption of copper and can result in CuDM. Our patient with CuDM, related to prior gastrectomy, excess zinc ingestion, and hypoceruloplasminemia, had a low serum zinc level. This likely reflected decreased zinc absorption due to his prior gastrectomy. Low serum zinc does not exclude CuDM. Disclosure: Dr. Josiah has nothing to disclose. Dr. Salomon has nothing to disclose. Dr. Tacker has nothing to disclose. Dr. Gutmann has received research support from Novartis, Biogen Idec, Genzyme Corporation and Boehringer-Inglheim Pharmaceuticals, Inc.