Zinc acetate
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Copper deficiency, pancytopenia and peripheral neuropathy: case report A 39-year-old woman developed copper deficiency, pancytopenia and peripheral neuropathy during treatment with zinc acetate for initial presumed diagnosis of Wilson disease (WD). The woman had a history of alcohol use. She had no relevant medical history and she was not taking any medication. She presented to the digestive and liver specialist with abdominal pain, nausea, vomiting and abnormal liver function tests and several weeks of tiredness. Based on her serum ceruloplasmin and liver copper concentrations, a presumed diagnosis of WD was made. She was suggested to avoid drinking alcohol and eat healthier meals. She started receiving treatment with zinc acetate 50mg three times a day in June 2015 [route not stated]. Subsequent investigations revealed pancytopenia and very low concentrations of copper in her serum and urine. In April 2017, she developed blurred vision and tingling in her hands and feet, findings confirming peripheral neuropathy [not all durations of treatments to reactions onsets stated]. Consequently, the woman’s treatment with zinc acetate was discontinued in January 2018. After she had stopped drinking alcohol and taking zinc acetate, her general health improved in October 2018 with normalisation of biochemical and haematological laboratory test results, including total serum copper concentrations. Her initial diagnosis of WD was reclassified as alcoholic steatohepatitis with suspected intrahepatic cholestasis. Author comment: "[A]lthough zinc supplementation is considered a safe treatment for [Wilson disease], it can lead to copper deficiencies and subsequent cytopenia and neurological injury in misdiagnosed patients." Martinez-Morillo E, et al. Pancytopenia and peripheral neuropathy in a woman with altered liver function tests. Clinical Chemistry 65: 956-960, No. 8, Aug 2019. Available from: URL: http://doi.org/10.1373/clinchem.2018.298927 803431315 Spain
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Reactions 2 Nov 2019 No. 1777
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