Ohmori Hiromitsu, Kodama Hiroko, Takemoto Masahiko, Yamasaki Masami, Matsumoto Tomio, Kumode Masao, Miyachi Takafumi, Sumimoto Ryo
Department of Pediatrics, National Hospital Organization Yanai Medical Center, Yanai 742-1352, Yamaguchi, Japan.
Doctoral Program in Health and Dietetics, Graduate School of Health Sciences, Teikyo Heisei University, Toshima-ku 170-8445, Tokyo, Japan.
World J Clin Cases. 2021 Oct 16;9(29):8825-8830. doi: 10.12998/wjcc.v9.i29.8825.
Percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) is often used to treat patients with neurological impairment and difficulty in swallowing. However, these patients often develop copper deficiency. This report describes a case of isolated neutropenia, which is a rare manifestation of copper deficiency.
Our patient was a 19-year-old boy with neurological impairment and gastroesophageal reflux. He received PEG-J feeding, including an enteral supplement containing copper and zinc. However, as his serum zinc level was low (53 μg/dL) at the age of 19 years and 2 mo, we changed to a zinc-rich supplement containing 22 mg/d of zinc and 1.0 mg/d of copper. The supplement comprised a mixture of isocal 1.0 junior (5 packs/d), Tezon [2 packs (250 mL)/d], and cocoa powder. Seven months later, he had neutropenia (606/mm) with a serum copper level of 16 μg/dL. There were no other manifestations of copper deficiency, including anemia. Copper deficiency and neutropenia both improved following the administration of cocoa powder and Tezon.
In patients receiving long-term PEG-J feeds, white blood cell counts, hemoglobin, and serum levels of copper and zinc should be regularly monitored.
经皮内镜下胃造口术并置空肠营养管（PEG-J）常用于治疗有神经功能障碍和吞咽困难的患者。然而，这些患者常出现铜缺乏。本报告描述了一例孤立性中性粒细胞减少症病例，这是铜缺乏的一种罕见表现。
我们的患者是一名19岁的男孩，有神经功能障碍和胃食管反流。他接受PEG-J喂养，包括一种含铜和锌的肠内营养补充剂。然而，在他19岁零2个月时，由于血清锌水平较低（53μg/dL），我们换成了一种富含锌的补充剂，含锌量为22mg/d，含铜量为1.0mg/d。该补充剂由能全素1.0 junior（5包/天）、特康（2包（250mL）/天）和可可粉混合而成。7个月后，他出现中性粒细胞减少症（606/mm），血清铜水平为16μg/dL。没有铜缺乏的其他表现，包括贫血。给予可可粉和特康后，铜缺乏和中性粒细胞减少症均得到改善。
在接受长期PEG-J喂养的患者中，应定期监测白细胞计数、血红蛋白以及铜和锌的血清水平。
