Case Report| Volume 34, ISSUE 2, P340.e5-340.e6, February 2016

The perfect storm: copper deficiency presenting as progressive peripheral neuropathy

      A number of patients present to the emergency department (ED) with complaints of peripheral neuropathy. This case report highlights on an underrecognized etiology of progressive neuropathy in a woman who presented to our ED. Clinical signs, symptoms, as well as a high index of suspicion suggested copper deficiency. Hypocupremia manifests itself as a debilitating peripheral sensory and motor neuropathy, anemia, leukopenia, and abnormal red blood cell morphologies on a peripheral blood smear. Significant risk factors for the development of this illness include Roux-en-Y gastric bypass; excess zinc supplementation; and, in some instances, postmenopausal females. The article reviews pertinent literature.
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        • Nagano T.
        • Toyoda T.
        • Tanabe H.
        • Nagato T.
        • Tsuchida T.
        • Kitamura A.
        • et al.
        Clinical features of hematological disorders caused by copper deficiency during long-term enteral nutrition.
        Intern Med. 2005; 44: 554-559
        • Bertinato J.
        • Abbe M.R.L.
        Maintaining copper homeostasis: regulation of copper-trafficking proteins in response to copper deficiency or overload.
        J Nutr Biochem. 2004; 15: 316-322
        • Griffith D.
        • Liff D.
        • Winston E.
        Acquired copper deficiency: a potentially serious and preventable complication following gastric bypass surgery.
        Obesity. 2009; 17: 827-831
        • O'Donnell K.
        • Simmons M.
        Early-onset copper deficiency following Roux-en-Y gastric bypass.
        Nutr Clin Pract. 2011; 26: 66-69
        • Koch T.R.
        • Finelli F.C.
        Postoperative metabolic and nutritional complications of bariatric surgery.
        Gastroenterol Clin N Am. 2010; 39: 109-124
        • Kumar N.
        • Ahlskog J.E.
        • Gross J.B.
        Acquired hypocupremia after gastric surgery.
        Clin Gastroenterol Hepatol. 2004; 2: 1074-1079
        • Schleper B.
        • Stuerenburg H.J.
        Copper deficiency-associated myelopathy in a 46-year-old woman.
        J Neurol. 2001; 248: 705-706
        • Shahidzadeh R.
        • Sridhar S.
        Profound copper deficiency in a patient with gastric bypass.
        Am J Gastroenterol. 2008; 103: 2660-2662
        • Wapnir R.A.
        Copper absorption and bioavailability.
        Am J Clin Nutr. 1998; 67: 1054S-1060S
        • Tan J.C.
        • Burns D.L.
        • Royden J.H.
        Severe ataxia, myelopathy, and peripheral neuropathy due to acquired copper deficiency in a patient with history of gastrectomy.
        JPEN. 2006; 30: 446-450
        • Gletsu-Miller N.
        • Broderius M.
        • Frediani J.K.
        • Zhao V.M.
        • Griffith D.P.
        • Davis Jr., S.S.
        • et al.
        Incidence and prevalence of copper deficiency following Roux-en-Y gastric bypass surgery.
        Int J Obes. 2012; 36: 328-335
        • Quinn J.
        • Harris C.
        • Kaye J.
        • Lind B.
        • Carter R.
        • Anekonda T.
        • et al.
        Gender effects on plasma and brain copper.
        Int J Alzheimers Dis. 2011; 2011 ([150916]): 4
        • Lopes P.A.
        • Santos M.C.
        • Vicente L.
        • Rodrigues M.O.
        • Pavao M.L.
        • Neve J.
        • et al.
        Trace element status (Se, Cu, Zn) in healthy Portuguese subjects of Lisbon population: a reference study.
        Biol Trace Elem Res. 2004; 101: 1-17
        • Goodman B.P.
        • Chong B.W.
        • Patel A.C.
        • Fletcher G.P.
        • Smith B.E.
        Copper deficiency myeloneuropathy resembling B12 deficiency: partial resolution of MR imaging findings with copper supplementation.
        AJNR. 2006; 27: 2112-2114