title: Clinically distinct presentations of copper deficiency myeloneuropathy and cytopenias in a patient using excessive zinc-containing denture adhesive.
abstract: OBJECTIVE
  While copper deficiency has long been known to cause cytopenias, copper deficiency myeloneuropathy is a more recently described entity. Here, we present the case of two clinically distinct presentations of acquired copper deficiency syndromes secondary to excessive use of zinc-containing denture adhesive over five years: myeloneuropathy and severe macrocytic anemia and neutropenia.
  
  
  METHODS
  Extensive laboratory testing and histologic evaluation of the liver and bone marrow, were necessary to rule out other disease processes and establish the diagnosis of copper deficiency.
  
  
  RESULTS
  The initial presentation consisted of a myelopathy involving the posterior columns. Serum and urine copper were significantly decreased, and serum zinc was elevated. On second presentation (five years later), multiple hematological abnormalities were detected. Serum copper was again decreased, while serum zinc was elevated.
  
  
  CONCLUSIONS
  Zinc overload is a preventable cause of copper deficiency syndromes. This rare entity presented herein highlights the importance of patient, as well as provider, education.
authors.affiliation: Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States.
authors.forename: Sahara J
authors.initials: SJ
authors.lastname: Cathcart
authors.affiliation: Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States. Electronic address: alina.sofronescu@unmc.edu.
authors.forename: Alina G
authors.initials: AG
authors.lastname: Sofronescu
mesh_terms: D000326:Adrenoleukodystrophy / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D000328:Adult; D000748:Anemia, Macrocytic / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D003300:Copper / Q000172:deficiency*; D003738:Dental Cements / Q000009:adverse effects*; D003778:Dentures; D005260:Female; D006801:Humans; D009503:Neutropenia / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D013577:Syndrome; D015032:Zinc / Q000009:adverse effects*
chemical_list: D003738:Dental Cements; D003300:Copper; D015032:Zinc
keywords: Copper deficiency; Cytopenia; Denture adhesive; Myeloneuropathy; Zinc