A 39 year old female presented to a District General Hospital with fatigue, light-headedness and shortness of breath. Investigations revealed an iron deficient anaemia, initially presumed due to poor diet. Clinical examination revealed a moderate cerebellar ataxia and spastic paraparesis. Investigations included normal MRI of Whole Spine and Vitamin B12 level. MRI Brain revealed abnormal T2 and FLAIR high signal within the superior aspect of the corticospinal tracks bilaterally.
Further investigation revealed low serum copper of 0.6 mcgmol/L (12.6–26.7), low serum caeruloplasmin of 0.05 g/L (0.16–0.45) and low twenty-four hour urinary copper of 0.05 mcgmol/24 hours (0–0.6) confirming copper deficiency. Serum zinc was elevated at 16.3mcgmol/L (8–15) at neurology clinic assessment, confirming the diagnosis of zinc toxicity. The patient's astute pharmacist highlighted the potential source of excess zinc ingestion as overuse of a well known denture adhesive.
A literature search and overview of the physiology of copper, zinc and iron metabolism helped to marry all aspects of the case supporting the diagnosis of copper deficiency secondary to zinc toxicity due to overuse of a zinc containing denture adhesive.