metallothionein and Neutropenia

Copper deficiency in humans can result in both anaemia and neurological symptoms affecting walking and balance. Recently zinc excess due to overuse of zinc-containing denture adhesive has been recognised as a potential cause of copper deficiency. Recovery from neurological symptoms with replacement therapy appears to be limited and so emphasis falls on education and early detection. Dentists are well placed to educate patients on use of denture adhesives and to detect early signs of copper deficiency in patients who may be using zinc-containing denture adhesive to excess. A case of a 58-year-old man diagnosed with copper deficiency myelopathy possibly due to zinc-containing denture cream overuse is presented.

Topics: Adhesives; Anemia, Macrocytic; Copper; Denture Retention; Humans; Male; Metallothionein; Middle Aged; Neutropenia; Paresthesia; Spinal Cord Diseases; Zinc

Copper deficiency is a rare cause of sideroblastic anemia and neutropenia that often is not suspected clinically. The morphologic findings in bone marrow, while not pathognomonic, are sufficiently characteristic to suggest the diagnosis, leading to further testing to establish the correct diagnosis. Excess zinc ingestion is among the causes of copper deficiency. We present 3 cases of zinc-induced copper deficiency in which the diagnosis first was suggested on the basis of bone marrow examination. The first patient was a 47-year-old man with a debilitating peripheral neuropathy that had progressed during the previous 18 months, mild anemia, and severe neutropenia. The second was a 21-year-old man receiving zinc supplementation for acrodermatitis enteropathica in whom moderate normocytic anemia and neutropenia developed. The third patient was a 42-year-old man with anemia, severe neutropenia, and a peripheral neuropathy that had progressed during 8 months. The bone marrow findings in all cases suggested copper deficiency, which was confirmed by further laboratory testing and determined to be due to zinc excess. The morphologic features, clinical manifestations, differential diagnosis, and pathogenetic mechanisms are discussed.

Topics: Adult; Anemia, Sideroblastic; Biopsy; Bone Marrow; Bone Marrow Examination; Copper; Diagnosis, Differential; Humans; Male; Metallothionein; Middle Aged; Neutropenia; Peripheral Nervous System Diseases; Zinc