Anemia following zinc treatment for Wilson’s disease: a case report and literature review

• Main Authors: Sha Cai, Jing-Yu Gong, Jing Yang, Jian-She Wang
• Format: Article
• Language: English
• Published: BMC 2019-07-01
• Series: BMC Gastroenterology
• Subjects: Wilson’s disease; Hepatolenticular degeneration; Zinc; Hypocupremia; Anemia
• Online Access: http://link.springer.com/article/10.1186/s12876-019-1038-5

Abstract Background Zinc therapy is considered an effective and safe treatment for Wilson’s disease. Hypocupremia-related anemia is rarely reported after long-term zinc administration or combination therapy with copper-chelating agent. Case presentation We herein report a 12-year-old girl with pre-symptomatic Wilson’s disease diagnosed 5 years ago who presented with severe anemia after high-dose oral zinc for 4 years and 4 months. Her hemoglobin was gradually restored to the normal range after the adjustment of zinc dose and diet therapy for 4 months. A review of the literature revealed eight patients with hypocupremia-associated anemia following zinc therapy for Wilson’s disease, including 7 adults and 1 child. The only child patient was a 16-year-old boy, in whom the zinc therapy was succession to penicillamine administration. Conclusions This is the first report worldwide that a child developed severe anemia following high-dose single zinc administration for Wilson’s disease. It highlights the importance of regular follow-up during zinc treatment and the involvement of specialists in the long-term management of Wilson’s disease. We hope that this will alert pediatricians the issue of zinc over-treatment.