Fundación Oftalmológica de Santander (FOSCAL), Bucaramanga, Colombia; Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
Fundación Oftalmológica de Santander (FOSCAL), Bucaramanga, Colombia.
Biomedica. 2023 Jun 30;43(2):171-180. doi: 10.7705/biomedica.6687.
Copper deficiency can present as myelopathy by the manifestation of sensory ataxia, secondary to demyelination of the posterior cords of the spinal cord, accompanied by cytopenia, mainly anemia, and leukopenia. Case series study of three patients with myelopathy due to copper deficiency, diagnosed and managed from 2020 to 2022 in a highly complex university hospital in Colombia. Regarding gender, two cases were female patients. The age range was between 57 and 68 years. In all three cases serum copper levels were decreased, and in two of these, different causes of myelopathy affecting the posterior cords of the spinal cord were ruled out, such as vitamin B12, vitamin E and folic acid deficiency, tabes dorsalis, myelopathy due to human immunodeficiency virus, multiple sclerosis and infection by the human lymphotropic virus type I and II, among others. However, at the moment of the myelopathy diagnosis, one patient had vitamin B12 deficiency associated with copper insufficiency. All three cases presented sensory ataxia, and in two, paraparesis was the initial motor deficit. The diagnostic approach must include copper levels assessment in every case of patients with chronic gastrointestinal pathology, chronic diarrhea, malabsorption syndrome, or significant reduction in dietary intake; and the development of neurological symptoms that may suggest cord involvement. It has been reported that a delay in diagnosis can lead to poor neurological outcomes.
铜缺乏可表现为脊髓后索脱髓鞘引起的感觉性共济失调性脊髓病,伴有细胞减少症,主要为贫血和白细胞减少症。本病例系列研究报告了 3 例因铜缺乏导致的脊髓病患者,他们于 2020 年至 2022 年在哥伦比亚一家高度复杂的大学医院被诊断和治疗。关于性别,2 例为女性患者。年龄范围在 57 岁至 68 岁之间。所有 3 例患者血清铜水平均降低,其中 2 例排除了影响脊髓后索的其他原因导致的脊髓病,如维生素 B12、维生素 E 和叶酸缺乏、脊髓痨、人类免疫缺陷病毒引起的脊髓病、多发性硬化症和人类嗜淋巴细胞病毒 I 和 II 感染等。然而,在诊断脊髓病时,1 例患者存在维生素 B12 缺乏症合并铜缺乏症。所有 3 例患者均出现感觉性共济失调,其中 2 例患者最初的运动缺陷为截瘫。在有慢性胃肠道疾病、慢性腹泻、吸收不良综合征或饮食摄入显著减少的患者中,每个病例都必须包括铜水平评估,以及可能提示脊髓受累的神经症状的诊断方法。据报道,诊断延迟可能导致不良的神经结局。