title: Wilson's disease with depression and parkinsonism.
abstract: Wilson's disease (WD) is an autosomal recessive disorder with reduced biliary excretion of copper plus impaired formation of ceruloplasmin, leading to copper accumulation in the liver, brain, kidney, and cornea. Clinical manifestations include liver damage, psychiatric symptoms, and neurological features. We report a 35-year-old woman with a history of deranged liver functions who had severe depression several years later and eventually presented with parkinsonian features. The underlying diagnosis is WD and family screening revealed WD in 2 other siblings. She could not tolerate penicillamine because of fever and leucopenia. While taking trientine hydrochloride and zinc sulphate, her parkinsonism improved and her depression remained in remission. WD should be considered in patients with unexplained liver function derangement or psychiatric symptoms. Early diagnosis and initiation of specific treatment are crucial in minimising any further cerebral and hepatic damage as well as securing possible improvement in organ functions.
authors.affiliation: Division of Neurology, University Department of Medicine, Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: K H
authors.initials: KH
authors.lastname: Chan
authors.forename: R T F
authors.initials: RT
authors.lastname: Cheung
authors.forename: K M
authors.initials: KM
authors.lastname: Au-Yeung
authors.forename: W
authors.initials: W
authors.lastname: Mak
authors.forename: T S
authors.initials: TS
authors.lastname: Cheng
authors.forename: S L
authors.initials: SL
authors.lastname: Ho
mesh_terms: D000328:Adult; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D001971:Bromocriptine / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000150:complications* / Q000473:pathology / Q000523:psychology; D005260:Female; D006527:Hepatolenticular Degeneration / Q000150:complications* / Q000473:pathology / Q000523:psychology; D006801:Humans; D008279:Magnetic Resonance Imaging; D020734:Parkinsonian Disorders / Q000150:complications* / Q000473:pathology / Q000523:psychology; D010396:Penicillamine / Q000627:therapeutic use; D013406:Suicide, Attempted; D014057:Tomography, X-Ray Computed; D014266:Trientine / Q000627:therapeutic use; D014282:Trihexyphenidyl / Q000627:therapeutic use
chemical_list: D000978:Antiparkinson Agents; D002614:Chelating Agents; D001971:Bromocriptine; D014282:Trihexyphenidyl; D010396:Penicillamine; D014266:Trientine