Lustrous White Erosions Surrounded by an Erythematous Mucosa: A Novel Endoscopic Finding of Gastric Lesions in Patients with Wilson Disease

Abstract

Wilson disease is an inherited copper metabolism disorder. We herein report a novel endoscopic finding in three men with Wilson disease. These patients underwent upper endoscopy due to gastrointestinal symptoms or during follow-up. In each case, endoscopy revealed lustrous white erosions surrounded by an erythematous mucosa in the greater curvature of the gastric body. A biopsy of the lesions showed orcein-positive tissue, indicating copper deposition, in the interstitial stroma and fundic glands of the mucosa. All patients had been receiving treatment with zinc acetate. These endoscopic findings might have been related to the cytotoxicity of the accumulated copper and zinc acetate.

Zinc Acetate Dihydrate Tablet-Associated Gastritis Occurring in a Post-Hematopoietic Stem Cell Transplant Recipient

“…In addition, gastric mucosal injury has recently been reported to be associated with zinc acetate dihydrate tablet intake. Kitagawa et al reported that in three cases of Wilson's disease treated with zinc acetate, lustrous white erosions surrounded by erythematous mucosa were observed in the greater curvature of the gastric corpus [ 8 ]. We retrospectively analyzed 47 patients who underwent upper gastrointestinal endoscopy while taking oral zinc acetate dihydrate [ 7 ].…”

“…The mechanism of zinc acetate dihydrate-associated gastric lesions has not yet been elucidated. Kitagawa et al reported that orcein-positive granules were observed in the fundic glands and interstitium of the stomach in three cases of Wilson's disease, suggesting cytotoxicity induced by copper deposition [ 8 ]. Although we performed energy-dispersive X-ray analysis of the biopsy specimen from another patient with hypozincemia, no copper or zinc was detected [ 15 ].…”

“…Zinc acetate dihydrate is generally safe and well tolerated. Meanwhile, erosions and ulcers have recently been reported in the stomach of patients taking zinc acetate dihydrate [ 7 , 8 ]. Herein, we describe a case of a patient who developed gastric ulcers after hematopoietic stem cell transplantation.…”