title: Copper deficiency masquerading as myelodysplastic syndrome.
abstract: We describe a woman with severe neutropenia and dependency on red blood cell transfusions who had previously undergone Billroth II surgery and whose bone marrow (BM) showed morphologic characteristics typical of myelodysplastic syndrome (MDS) with ringed sideroblasts. She had transient reversal of anemia and severe neutropenia after therapy with erythropoietin and granulocyte colony-stimulating factor. Because of relapse while receiving growth factors, the patient was referred for allogeneic BM transplantation. A pretransplantation nutritional evaluation revealed severe copper deficiency, and her hematologic abnormalities resolved fully with copper therapy. This case shows that copper deficiency should be an integral part of the differential diagnosis of sideroblastic MDS, even in patients not requiring parenteral nutrition.
authors.affiliation: Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Xylina T
authors.initials: XT
authors.lastname: Gregg
authors.forename: Vishnu
authors.initials: V
authors.lastname: Reddy
authors.forename: Josef T
authors.initials: JT
authors.lastname: Prchal
mesh_terms: D000328:Adult; D000756:Anemia, Sideroblastic / Q000473:pathology; D001853:Bone Marrow / Q000473:pathology; D016026:Bone Marrow Transplantation; D003300:Copper / Q000172:deficiency* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D009190:Myelodysplastic Syndromes / Q000473:pathology; D009503:Neutropenia; D012008:Recurrence
chemical_list: D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor; D003300:Copper