Myelopathy due to copper deficiency: A case series and review of the literature
Abstract
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.
Downloads
References
Altarelli M, Ben-hamouda N, Schneider A, Berger M. Copper deficiency: causes, manifestations, and treatment. Nutr Clin Pract. 2019;34:504-13. https://doi.org/10.1002/ncp.10328
Moon N, Aryan M, Westerveld D, Nathoo S, Glover S, Kamel AY. Clinical manifestations of copper deficiency: a case report and review of the literature. Nutr Clin Pract. 2021;36:1080-5. https://doi.org/10.1002/ncp.10582
Turnlund JR. Human whole-body copper metabolism. Am J Clin Nutr. 1998;67:960-4. https://doi.org/10.1093/ajcn/67.5.960S
European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies. Scientific opinion on dietary reference values for copper. EFSA J. 2015;13:4253. https://doi.org/10.2903/j.efsa.2015.4253
Goodman BP. Metabolic and toxic causes of myelopathy. Continuum (Minneap. Minn). 2015;21:84-99. https://doi.org/10.1212/01.CON.0000461086.79241.3b
Slama MCC, Berkowitz AL. Metabolic and toxic myelopathies. Semin Neurol. 2021;41:427-40. https://doi.org/10.1055/s-0041-1725150
Gletsu-Miller N, Broderius M, Frediani JK, Zhao VM, Griffith DP, Davis SS, et al. Incidence and prevalence of copper deficiency following Roux-en-y gastric bypass surgery. Int J Obes. 2012;36:328-35. https://doi.org/10.1038/ijo.2011.159
Chhetri SK, Mills RJ, Shaunak S, Emsley HCA. Copper deficiency. BMJ. 2014;348:g3691. https://doi.org/10.1136/bmj.g3691
Naismith RT, Shepherd JB, Weihl CC, Tutlam NT, Cross AH. Acute and bilateral blindness due to optic neuropathy associated with copper deficiency. Arch Neurol. 2009;66:1025-7. https://doi.org/10.1001/archneurol.2009.70
Myint ZW, Oo TH, Thein KZ, Tun AM, Saeed H. Copper deficiency anemia: review article. Ann Hematol. 2018;97:1527–34. https://doi.org/10.1007/s00277-018-3407-5
Halfdanarson TR, Kumar N, Li C, Phyliky RL, Hogan WJ. Hematological manifestations of copper deficiency: a retrospective review. Eur J Haematol. 2008;80:523-31. https://doi.org/10.1111/j.1600-0609.2008.01050.x
Kumar P, Hamza N, Madhok B, De Alwis N, Sharma M, Miras AD, et al. Copper deficiency after gastric bypass for morbid obesity: a systematic review. Obes Surg. 2016;26:1335-42. https://doi.org/10.1007/s11695-016-2162-8
Lewis CA, de Jersey S, Seymour M, Hopkins G, Hickman I, Osland E. Iron, vitamin B12, folate and copper deficiency after bariatric surgery and the impact on anaemia: a systematic review. Obes Surg. 2020;30:4542–91. https://doi.org/10.1007/s11695-020-04872-y
Poujois A, Djebrani-Oussedik N, Ory-Magne F, Woimant F. Neurological presentations revealing acquired copper deficiency: diagnosis features, aetiologies and evolution in seven patients. Intern Med J. 2018;48:535-40. https://doi.org/10.1111/imj.13650
Huff JD, Keung YK, Thakuri M, Beaty MW, Hurd DD, Owen J, et al. Copper deficiency causes reversible myelodysplasia. Am J Hematol. 2007;82:625–30. https://doi.org/10.1002/ajh.20864
Farkas GJ, Pitot MA, Berg AS, Gater DR. Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis. Spinal Cord. 2019;57:3–17. https://doi.org/10.1038/s41393-018-0218-4
Gwathmey KG, Grogan J. Nutritional neuropathies. Muscle Nerve. 2020;62:13-29. https://doi.org/10.1002/mus.26783
Goodman BP, Bosch EP, Ross MA, Hoffman-Snyder C, Dodick DD, Smith BE. Clinical and electrodiagnostic findings in copper deficiency myeloneuropathy. J Neurol Neurosurg Psychiatry. 2009;80:524-7. https://doi.org/10.1136/jnnp.2008.144683
Wazir SM, Ghobrial I. Copper deficiency, a new triad: anemia, leucopenia, and myeloneuropathy. J Community Hosp Intern Med Perspect. 2017;7:265-8. https://doi.org/10.1080/20009666.2017.1351289
Kranz PG, Amrhein TJ. Imaging approach to myelopathy: acute, subacute, and chronic. Radiol Clin North Am. 2019;57:257-79. https://doi.org/10.1016/j.rcl.2018.09.006
Sarbu N, Lolli V, Smirniotopoulos JG. Magnetic resonance imaging in myelopathy: a pictorial review. Clin Imaging. 2019;57:56-68. https://doi.org/10.1016/j.clinimag.2019.05.002
Schwendimann R. Metabolic and toxic myelopathies. Continuum (Minneap. Minn). 2018; 24:427-40. https://doi.org/10.1212/CON.0000000000000596
Kumar N. Neurologic presentations of nutritional deficiencies. Neurol Clin. 2010;28:107-70. https://doi.org/10.1016/j.ncl.2009.09.006
Urtiaga S, Terrero R, Malumbres M, Pinel A. Mielopatía por déficit de cobre: la gran simuladora. Neurologia. 2018;33:278-81. https://doi.org/10.1016/j.nrl.2017.02.009
Mechanick JI, Youdim A, Jones DB, Garvey T, Hurley DL, McMahon M, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl.1):S1-27. https://doi.org/10.1002/oby.20461
Some similar items:
- Rosa Magdalena Uscátegui, Adriana M. Correa, Jaime Carmona-Fonseca, Changes in retinol, hemoglobin and ferritin concentrations in Colombian children with malaria , Biomedica: Vol. 29 No. 2 (2009)
- Elpidia Poveda, Alexandra Cuartas, Saralicia Guarín, Yibby Forero, Elsa Villarreal, Iron and vitamin A micronutrient status, risk factors for their deficiencies and anthropometric assessment in preschool child from Funza municipality, Colombia , Biomedica: Vol. 27 No. 1 (2007)
- Margarita Arboleda, María Fernanda Pérez, Diana Fernández, Luz Yaned Usuga, Miler Meza, Clinical and laboratory profile of Plasmodium vivax malaria patients hospitalized in Apartadó, , Biomedica: Vol. 32 (2012): Suplemento 1, Malaria
- Claudia Liliana Durán, Olga Lucía Morales, Sandra Johanna Echeverri, Mario Isaza, Beta globin haplotypes in hemoglobin S carriers in Colombia , Biomedica: Vol. 32 No. 1 (2012)
- Beatriz Elena Parra, Luz Mariela Manjarrés, Alba Lucía Gómez, Dora María Alzate, María Clemencia Jaramillo, Assessment of nutritional education and iron supplement impact on prevention of pregnancy anemia. , Biomedica: Vol. 25 No. 2 (2005)
- Lorena Matta, Mario M. Barbosa, Cristhian D. Morales-Plaza, Clinical profile of dengue in patients consulting a tertiary hospital in the city of Cali, Colombia, 2013 , Biomedica: Vol. 36 No. 1 (2016)
- Cristian Fong, Stephan Menzel, María Alejandra Lizarralde, Guillermo Barreto, Genetic variants associated with fetal hemoglobin levels show the diverse ethnic origin in Colombian patients with sickle cell anemia , Biomedica: Vol. 35 No. 3 (2015)
- Ángela Medina, David López, Luis Reinel Vásquez, Severe pediculosis capitis in a nursery school girl , Biomedica: Vol. 39 No. 4 (2019)
- Carlos Julio Vargas-Potes, Diana Marcela Mendoza-Urbano, Luis Gabriel Parra-Lara , Ángela R. Zambrano, Challenges in the care of Ewing’s sarcoma in a Jehovah’s Witness patient , Biomedica: Vol. 43 No. 1 (2023)
Copyright (c) 2023 Biomedica
This work is licensed under a Creative Commons Attribution 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
