Abstract Details

Title Symptomatic Copper Deficiency Masquerading as Paraneoplastic Syndrome

Topic General Neurology

Presentation(s) P9 - Poster Session 9 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-005

Objective To describe an unusual case of symptomatic copper deficiency initially suspected to be paraneoplastic syndrome.

Background Copper deficiency is exceedingly rare, especially in developed nations, and is usually the result of genetic deficit. It often presents with neuropathy, weakness and encephalopathy. In this case, we describe a case of copper deficiency presenting with weakness, hallucinations and encephalopathy initially mistaken for paraneoplastic syndrome in a patient recently diagnosed with breast cancer.

Design/Methods NA

Results Our patient is a 58 year old female with a history of recently diagnosed breast cancer who presented with new-onset lower extremity weakness and confusion. She was initially admitted to the medical-oncology service for management of her malignancy. During her hospitalization, she developed frank hallucinations and worsening encephalopathy. Neurologic workup including MRI brain, C and T-Spine, EEG, lumbar puncture with basic studies and autoimmune panel were negative. She got 3 days of IVIG and 5 days of PLEX with no improvement. The patient’s sister revealed for 8 weeks she had only been eating vegetables grown in her own garden. EMG revealed axonal sensorimotor neuropathy. Serum vitamins were checked and revealed a copper level of 30 ug/dL (80-120 ug/dL). She was started on IV copper replacement and slowly improved; she was seen in the clinic six months later with marked improvement of her mentation, but persistent lower extremity paraparesis.

Conclusions While vitamin deficiency—especially copper deficiency—is rare, it should be considered in cases where patients with weakness and neuropsychiatric symptoms have a benign neurologic workup and fail to respond to conventional immunologic therapies.

Authors/Disclosures
Connor D. Welsh, DO (Barrow Neurological Institute) PRESENTER	Dr. Welsh has nothing to disclose.
Justin Hoskin, MD (Barrow Neurological Institute)	Dr. Hoskin has nothing to disclose.

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