P2626 - Copper Deficiency Myeloneuropathy Secondary to Gastric Bypass Surgery

Lini Thomas, DO, Sowmya Kalathuru, DO, Shelby Hocker, DO, Jefferson Tran, , Thomas Tran, MD, Douglas Myers, MD
TMC, Denison, TX

Introduction: Copper deficiency myeloneuropathy is a rare neurological syndrome characterized by posterior column dysfunction of the spinal cord. Causes include bariatric surgeries, malabsorption, and zinc supplementation. We present a case of copper deficiency myeloneuropathy secondary to gastric bypass surgery.

Case Description/Methods: The patient is a 45-year-old woman with a history of obesity treated with Roux-en-Y gastric bypass 3 years ago resulting in 100 pounds of weight loss. She was placed on zinc supplement. For several months, she has had progressively worsening coldness, numbness, and cramping pain in all extremities. The patient was hospitalized after being found unresponsive at home. She was noted to have lower extremity spasticity and sustained clonus with hyperreflexia in all extremities. She had a sensory level deficit up to the T10 dermatome. The patient’s brain, cervical, thoracic, and lumbar MRI were unremarkable. Lumbar puncture showed normal cerebrospinal fluid. Cardiac workup was negative for postural orthostatic tachycardia syndrome and neurocardiogenic syncope. Hgb was 12. Vitamin B12 level was normal. Copper level was 37 mcg/dL (normal range 62-140 mcg/dL). She was determined to have subacute degeneration of the spinal cord secondary to copper deficiency caused by zinc supplementation and gastric bypass. The patient was treated with IV copper chloride 2.4 mg infusions daily. Repeat copper level after 5 days of infusions was 73 mcg/dL. Patient’s symptoms improved, and she was discharged to rehabilitation on oral copper supplementation.

Discussion: Copper deficiency can result in myeloneuropathy and anemia. Causes of copper deficiency include bariatric surgeries (47%), zinc toxicity (16%), malabsorption (15%), iron ingestion (2%), and idiopathic (20%). After bariatric surgeries, zinc supplementation is often prescribed because zinc is known to restore gastric lining and heal other parts of the GI tract. However, excessive zinc supplementation can lower serum copper level as these two elements compete for a binding site on the divalent metal transporter 1 molecule on the small intestinal epithelium. Treatment consists of copper supplement, physical therapy, and occupational therapy. Clinicians should be aware of copper deficiency in patients with a history of gastric bypass surgery.


Disclosures:


Lini Thomas, DO, Sowmya Kalathuru, DO, Shelby Hocker, DO, Jefferson Tran, , Thomas Tran, MD, Douglas Myers, MD. P2626 - Copper Deficiency Myeloneuropathy Secondary to Gastric Bypass Surgery, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.