Draine Jillian, Simmons Matthew
University of South Dakota Sanford School of Medicine.
Regional Health Neurology and Rehabilitation, Rapid City, South Dakota.
S D Med. 2020 Apr;73(4):178-180.
In this report, we present a case of acquired copper deficiency which initially presented as progressive pain and numbness in the patient's lower extremities. The acquired copper deficiency is attributed to a previous bariatric surgery exacerbated by zinc toxicity. A 42-year-old female with a past medical history of type 2 diabetes mellitus, anemia, hypertension, bipolar disorder, attention deficit disorder, pulmonary embolus, fibromyalgia, migraine headaches, and chronic pain as well as a remote past surgical history of gastric bypass procedure presented with progressive pain and numbness in her lower extremities. The patient reported chronic use of zinc supplements. Clinical evaluation revealed abnormal neurologic exam consistent with a myeloneuropathy and anemia. A cervical spine MRI showed increased signal intensity primarily affecting the posterior columns from C2-C6. Laboratory studies confirmed low copper, low ceruloplasmin, and elevated zinc levels. This case is an example of acquired copper deficiency due to previous bariatric surgery exacerbated by zinc ingestion. With an increased prevalence of bariatric surgery, it is important to monitor patients postoperatively for neurologic symptoms potentially due to copper deficiency.
在本报告中，我们呈现了一例获得性铜缺乏病例，该病例最初表现为患者下肢进行性疼痛和麻木。获得性铜缺乏归因于既往减肥手术，锌中毒使其病情加重。一名42岁女性，有2型糖尿病、贫血、高血压、双相情感障碍、注意力缺陷障碍、肺栓塞、纤维肌痛、偏头痛和慢性疼痛病史，既往有胃旁路手术史，现出现下肢进行性疼痛和麻木。患者报告长期服用锌补充剂。临床评估显示神经系统检查异常，符合脊髓神经病和贫血表现。颈椎磁共振成像（MRI）显示信号强度增加，主要累及C2 - C6的后柱。实验室检查证实铜水平低、铜蓝蛋白低且锌水平升高。该病例是既往减肥手术因摄入锌而加重导致获得性铜缺乏的一个实例。随着减肥手术患病率的增加，术后监测患者是否出现可能由铜缺乏引起的神经症状很重要。
