•53 yr old woman; 4-8 capsules of Zinc
gluconate (50mg) >1yr
•Spastic and ataxic gait, tingling and
numbness in fingers and feet
•Evidence of a sensory and motor neuropathy in
the lower limbs and decreased
vibration and proprioception senses
•Haemoglobin 8.3g/dl (11.7-15.7)
MCV 112.5 uM (80-100)
WBC count 2.6 x103 (3.8 - 10.8)
•Normal vitamin B12, folate, immune function,
brain and spine MRI
•Serum copper 7 ug/dl (70-150)
serum zinc
2.28 ug/ml (0.66-1.1)
•Treated with oral copper 2mg per day
Full haematological but
only partial neurological recovery
Parenteral
copper might be required in severe cases