title: Resolution of decompensated cirrhosis from Wilson's disease with zinc monotherapy: a potential therapeutic option?
abstract: OBJECTIVE
  Wilson's disease is a genetic autosomal-recessive copper deposition disorder often presenting with neurologic or hepatic symptoms. In cases of hepatic presentation, treatment usually is initiated with potentially toxic copper chelators, such as D-penicillamine or trientine. Although multiple studies have introduced zinc as a low-toxicity and low-cost Wilson's disease treatment, its use has been limited to adjunctive or single-agent maintenance options. In this report, we describe the use of zinc monotherapy in a patient with severe hepatic presentation of Wilson's disease.
  
  
  METHODS
  Zinc has not been evaluated as a single-agent treatment option for active hepatic Wilson's disease. Zinc monotherapy was initiated for a single patient with fulminant hepatic failure caused by Wilson's disease while awaiting liver transplantation.
  
  
  RESULTS
  Over a 1-year period with zinc monotherapy, this patient experienced normalization of hepatic synthetic function and resolution of hypoalbuminemia and coagulopathy. Clinical stabilization of variceal bleeds, ascites, and lower-extremity edema also were observed. The patient is no longer a transplant candidate as a result of clinical recovery and improvement of Model for End-stage Liver Disease and Child-Turcotte-Pugh scores.
  
  
  CONCLUSIONS
  This case highlights the potential use of zinc as a low-toxicity and low-cost single-agent treatment in severely decompensated hepatic Wilson's disease. Despite promising results in this case, further clinical evaluation will be necessary to assess fully the clinical efficacy of zinc monotherapy.
authors.affiliation: Department of Internal Medicine, University of Virginia Health System, Charlottesville, 22908, USA.
authors.forename: Vanessa D
authors.initials: VD
authors.lastname: Lee
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
authors.forename: Carl L
authors.initials: CL
authors.lastname: Berg
mesh_terms: D005260:Female; D006527:Hepatolenticular Degeneration / Q000150:complications*; D006801:Humans; D017114:Liver Failure, Acute / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D020127:Recovery of Function; D019287:Zinc Sulfate / Q000627:therapeutic use*
chemical_list: D019287:Zinc Sulfate