title: Penicillamine-related lichenoid dermatitis and utility of zinc acetate in a Wilson disease patient with hepatic presentation, anxiety and SPECT abnormalities.
abstract: Wilson's disease is an autosomal recessive disorder of hepatic copper metabolism with consequent copper accumulation and toxicity in many tissues and consequent hepatic, neurologic and psychiatric disorders. We report a case of Wilson's disease with chronic liver disease; moreover, in our patient, presenting also with high levels of state anxiety without depression, 99mTc-ECD-SPECT showed cortical hypoperfusion in frontal lobes, more marked on the left frontal lobe. During the follow-up of our patient, penicillamine was interrupted after the appearance of a lichenoid dermatitis, and zinc acetate permitted to continue the successful treatment of the patient without side-effects. In our case the therapy with zinc acetate represented an effective treatment for a Wilson's disease patient in which penicillamine-related side effects appeared. The safety of the zinc acetate allowed us to avoid other potentially toxic chelating drugs; this observation is in line with the growing evidence on the efficacy of the drug in the treatment of Wilson's disease. Since most of Wilson's disease penicillamine-treated patients do not seem to develop this skin lesion, it could be conceivable that a specific genetic factor is involved in drug response. Further studies are needed for a better clarification of Wilson's disease therapy, and in particular to differentiate specific therapies for different Wilson's disease phenotypes.
authors.forename: L
authors.initials: L
authors.lastname: Leggio
authors.forename: A
authors.initials: A
authors.lastname: Ferrulli
authors.forename: A
authors.initials: A
authors.lastname: Mirijello
authors.forename: L
authors.initials: L
authors.lastname: Abenavoli
authors.forename: D
authors.initials: D
authors.lastname: Di Giuda
authors.forename: S
authors.initials: S
authors.lastname: Funiciello
authors.forename: M
authors.initials: M
authors.lastname: Rotoli
authors.forename: G
authors.initials: G
authors.lastname: Gasbarrini
authors.forename: G
authors.initials: G
authors.lastname: Addolorato
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001007:Anxiety / Q000150:complications* / Q000523:psychology*; D001252:Astringents / Q000627:therapeutic use*; D005260:Female; D006527:Hepatolenticular Degeneration / Q000150:complications* / Q000000981:diagnostic imaging / Q000523:psychology; D006801:Humans; D017512:Lichenoid Eruptions / Q000139:chemically induced* / Q000188:drug therapy*; D008107:Liver Diseases / Q000150:complications*; D008111:Liver Function Tests; D010396:Penicillamine / Q000009:adverse effects*; D015899:Tomography, Emission-Computed, Single-Photon; D019345:Zinc Acetate / Q000627:therapeutic use*
chemical_list: D018501:Antirheumatic Agents; D001252:Astringents; D019345:Zinc Acetate; D010396:Penicillamine