title: When metals compete: a case of copper-deficiency myeloneuropathy and anemia.
abstract: BACKGROUND
  A 47-year-old woman with an otherwise unremarkable medical history was referred to the multiple sclerosis clinic by her primary neurologist for evaluation of a 2-3 year history of progressive knee and back pain, weakness, paresthesias, sensory loss, ataxia, and falls. During the same period, she had received blood transfusions for unexplained anemia and leukopenia. She had been wearing dentures for many years.
  
  
  METHODS
  Physical examination, neurological examinations (assessments of reflexes, gait, proprioception, and sensitivity to temperature, pinprick and vibration), neurophysiological studies (visual and brainstem somatosensory evoked potentials, nerve conduction studies and electromyography), T(2)-weighted MRI of the brain and spine, cerebrospinal fluid analysis and serum evaluations.
  
  
  METHODS
  Myeloneuropathy and anemia due to copper deficiency, secondary to zinc overload associated with long-term use of denture cream with a high zinc content.
  
  
  RESULTS
  Change to a low-zinc denture cream and oral copper replacement.
authors.affiliation: Thomas Jefferson University, PA, USA. spainr@ohsu.edu
authors.forename: Rebecca I
authors.initials: RI
authors.lastname: Spain
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Leist
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: De Sousa
mesh_terms: D000740:Anemia / Q000150:complications / Q000209:etiology / Q000378:metabolism; D003300:Copper / Q000172:deficiency*; D005260:Female; D006801:Humans; D008875:Middle Aged; D013118:Spinal Cord Diseases / Q000150:complications / Q000209:etiology / Q000378:metabolism
chemical_list: D003300:Copper