Singh Gurjot, Goswami Kanishka, Farooq Amna, Trehan Shubam, Arora Rajpreet S, Bector Gaurav, Kamal Syeda Ashna Fatima, Azhar Waqas
Internal Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND.
Hematology and Oncology, Southern Illinois University School of Medicine, Springfield, USA.
Cureus. 2024 Aug 13;16(8):e66765. doi: 10.7759/cureus.66765. eCollection 2024 Aug.
Copper deficiency can mimic myelodysplastic syndrome, a group of heterogeneous hematopoietic disorders characterized by peripheral cytopenias, with potential progression to bone marrow failure and acute myeloid leukemia. We present the case of an 83-year-old female with a history of Graves' disease, early-stage hormone receptor-positive breast cancer, hypertension, and glaucoma, who presented with fatigue and progressive lower extremity weakness. Laboratory tests revealed macrocytic anemia, neutropenia, and lymphopenia, with normal platelet counts. Bone marrow biopsy showed trilineage hematopoiesis, dyserythropoiesis, ring sideroblasts, and vacuoles in erythroid precursors, indicating copper deficiency. The patient had been using zinc oxide paste for dentures and had increased her zinc intake during the COVID-19 pandemic, leading to severe copper deficiency. Treatment with intravenous and oral copper supplementation resulted in marked improvement in hematologic indices and symptoms. This case underscores the importance of considering copper deficiency in the differential diagnosis of cytopenias and myeloneuropathy in elderly patients, particularly those with a history of excessive zinc intake.
铜缺乏可酷似骨髓增生异常综合征，这是一组异质性造血疾病，其特征为外周血细胞减少，有进展为骨髓衰竭和急性髓系白血病的可能。我们报告一例83岁女性病例，她有格雷夫斯病、早期激素受体阳性乳腺癌、高血压和青光眼病史，出现疲劳和进行性下肢无力。实验室检查显示大细胞性贫血、中性粒细胞减少和淋巴细胞减少，血小板计数正常。骨髓活检显示三系造血、红细胞生成异常、环形铁粒幼细胞以及红系前体细胞中的空泡，提示铜缺乏。该患者一直在使用氧化锌糊剂制作假牙，并且在新冠疫情期间增加了锌的摄入量，导致严重铜缺乏。静脉和口服补充铜治疗后，血液学指标和症状有显著改善。该病例强调了在老年患者血细胞减少和骨髓神经病的鉴别诊断中考虑铜缺乏的重要性，尤其是那些有过量锌摄入史的患者。
