A 30-year-old with irritable bowel syndrome on a laxative treatment presented with a two-month history of intermittent muscle spasm, bilateral lower extremity paresthesia, and generalized weakness. Neurological exam showed upper motor neuron signs (spasticity, hyperreflexia, clonus, Hoffman’s sign), and spastic gait.
MRI brain and cervical spine, and EMG were unremarkable. Autoimmune myelopathy panel was negative. Infectious workup, including HIV, syphilis, and HTLV I/II, was unrevealing. Serum copper was low (74 µg/dL, normal 80–158 µg/dL), but serum zinc and vitamin B12 levels were within normal limits.
The patient improved with 2mg of oral copper supplement and cessation of laxative use. A year later, the patient became pregnant and was monitored with monthly copper, zinc, folate, and ceruloplasmin levels. She required increased copper dose to 6mg during her 1st trimester, and stopped copper supplements in her 2nd trimester, with complete resolution of symptoms.