RESUMO
INTRODUCTION: Neurological involvement associated with copper deficiency has been reported recently in humans and may be under-recognized. CASE REPORT: A 65-year-old patient, with past history of gastrectomy 40 years earlier, developed a myelodysplastic syndrome and then subacute onset of progressive gait ataxia and paresthesias in the lower extremities. Serum vitamin B12 level was low but neurological deterioration persisted, despite vitamin replacement therapy and normal cobalamin level. Further diagnostic investigations revealed severe copper deficiency. Copper supplementation led to hematologic improvement and neurological stabilization. CONCLUSION: Copper and vitamin B12 deficiency, due to malabsorption as a cause of progressive neuromyelopathy and hematologic manifestations, may coexist.
Assuntos
Anemia Refratária com Excesso de Blastos/etiologia , Ataxia/etiologia , Cobre/deficiência , Síndromes de Malabsorção/etiologia , Síndromes Pós-Gastrectomia/complicações , Idoso , Cobre/farmacocinética , Cobre/uso terapêutico , Humanos , Masculino , Distúrbios Somatossensoriais/etiologia , Deficiência de Vitamina B 12/diagnóstico , Deficiência de Vitamina B 12/etiologia , Complexo Vitamínico B/uso terapêuticoRESUMO
Ingestion of star fruit (Averrhoa carambola) can induce severe intoxication in subjects with chronic renal failure. Oxalate plays a key role in the neurotoxicity of star fruit. We report the cases of two patients with unknown chronic renal insufficiency who developed severe encephalopathy after ingestion of star fruit. The two patients developed intractable hiccups, vomiting, impaired consciousness and status epilepticus. Diffusion-weighted MR imaging showed cortical and thalamic hyperintense lesions related to epileptic status. They improved after being submitted to continuous hemofiltration which constitutes the most effective treatment during the acute phase.