Open AccessAcquired copper deficiency myeloneuropathy with resolution Only after reversion of Roux-en-Y gastrojejunostomy: a case report
Author(s) -
Paulo de Lima Serrano,
Igor Braga Farias,
Bruno de Mattos Lombardi Badia,
José Laredo Filho,
Paulo Victor Sgobbi de Souza,
Wladimir Bocca Vieira de Rezende Pinto,
Victor Hugo Rocha Marussi,
Acary Souza Bullé Oliveira
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.158
Subject(s) - medicine , copper deficiency , surgery , roux en y anastomosis , magnetic resonance imaging , anemia , weight loss , gastric bypass , obesity , radiology , chemistry , organic chemistry , copper
The performance of bariatric surgeries has increased in recente years. Secondary mal- absorptive syndrome is an important cause of acquired copper deficiency, especially after Roux-em-Y gastric by-pass. The clinical manifestation of this deficiency disorder can occur years or decades after the surgery. Objective: To describe the course, clinical manifestations, therapeutic approaches and to raise concern about acquired copper deficiency in patients who underwent bariatric surgery. Methods: A case report seen in the neuromuscular service of the federal university of São Paulo.SP. Results: The patient underwent Roux-en-Y gastrojejunostomy in 2010, 6 years before the initial manifestations of paresthesia on the lower limbs and anemia. The symptons progressed to imbalance and falls. Magnetic resonance image depicted T2 hyperintense signal in the posterior column from C4- T4. A Vitamin B12 deficiency was considered to be the cause but intramuscular therapy was ineffective. The neurological condition deteriorated and the patient was unable to walk without a walker. A severe copper deficiency was diagnosed but oral and intravenous replacement did not improve the clinical picture. Only after reversion of the Roux-em-Y gastric by-pass that the patient improved. Conclusion: Obesity is growing health problem and the incidence of bariatric surgery is increasing. Acquire copper deficiency should always be on mind when facing a patient with myeloneuropathy that underwent these group of surgeries. Rapidly installed therapeutic approach can prevent neurological sequelae.