Subacute copper-deficiency myelopathy in a patient with occult celiac disease

Cavallieri, Francesco; Fini, Nicola; Contardi, Sara; Fiorini, Massimo; Corradini, Elena; Valzania, Franco

doi:10.1080/10790268.2016.1246639

Cited by 12 publications

(12 citation statements)

References 7 publications

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“…The exact prevalence of copper deficiency in active CeD is unclear, but conditions associated with malabsorption of macronutrients and gastrointestinal disease can impair copper uptake and contribute to suboptimal copper status. This deficiency can lead to anemia, thrombocytopenia, neutropenia, peripheral neuronal involvement, and myelopathy [ 206 , 207 , 208 , 209 , 210 , 211 ].…”

Section: Consequences Of Nutrient Malabsorptionmentioning

confidence: 99%

Small and Large Intestine (I): Malabsorption of Nutrients

2021

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Numerous disorders can alter the physiological mechanisms that guarantee proper digestion and absorption of nutrients (macro- and micronutrients), leading to a wide variety of symptoms and nutritional consequences. Malabsorption can be caused by many diseases of the small intestine, as well as by diseases of the pancreas, liver, biliary tract, and stomach. This article provides an overview of pathophysiologic mechanisms that lead to symptoms or complications of maldigestion (defined as the defective intraluminal hydrolysis of nutrients) or malabsorption (defined as defective mucosal absorption), as well as its clinical consequences, including both gastrointestinal symptoms and extraintestinal manifestations and/or laboratory abnormalities. The normal uptake of nutrients, vitamins, and minerals by the gastrointestinal tract (GI) requires several steps, each of which can be compromised in disease. This article will first describe the mechanisms that lead to poor assimilation of nutrients, and secondly discuss the symptoms and nutritional consequences of each specific disorder. The clinician must be aware that many malabsorptive disorders are manifested by subtle disorders, even without gastrointestinal symptoms (for example, anemia, osteoporosis, or infertility in celiac disease), so the index of suspicion must be high to recognize the underlying diseases in time.

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Section: Consequences Of Nutrient Malabsorptionmentioning

confidence: 99%

Small and Large Intestine (I): Malabsorption of Nutrients

2021

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“…Halfdanarion et al [51] reported five cases of adult celiac patients with copper deficiency; all of them presented neurological complications and three of them presented hematological abnormalities. Cavallieri et al [52] recently described a rare case of myelopathy induced by copper deficiency secondary to undiagnosed CD, and they have suggested that patients with hypocupremia should be tested for CD.…”

Section: Micronutrient Deficiencies and Celiac Diseasementioning

confidence: 99%

“…IFN-γ also decreases the mRNA of the transmembrane protein ferroportin, which exports iron to the outside of the cells. Therefore, IFN-γ favors iron retention within monocytes [52].…”

Section: Anemia Of Chronic Diseasementioning

confidence: 99%

Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review

et al. 2019

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Celiac disease (CD) is a multisystemic disorder with different clinical expressions, from malabsorption with diarrhea, anemia, and nutritional compromise to extraintestinal manifestations. Anemia might be the only clinical expression of the disease, and iron deficiency anemia is considered one of the most frequent extraintestinal clinical manifestations of CD. Therefore, CD should be suspected in the presence of anemia without a known etiology. Assessment of tissue anti-transglutaminase and anti-endomysial antibodies are indicated in these cases and, if positive, digestive endoscopy and intestinal biopsy should be performed. Anemia in CD has a multifactorial pathogenesis and, although it is frequently a consequence of iron deficiency, it can be caused by deficiencies of folate or vitamin B 12 , or by blood loss or by its association with inflammatory bowel disease (IBD) or other associated diseases. The association between CD and IBD should be considered during anemia treatment in patients with IBD, because the similarity of symptoms could delay the diagnosis. Vitamin B 12 deficiency is common in CD and may be responsible for anemia and peripheral myeloneuropathy. Folate deficiency is a well-known cause of anemia in adults, but there is little information in children with CD; it is still unknown if anemia is a symptom of the most typical CD in adult patients either by predisposition due to the fact of age or because biochemical and clinical manifestations take longer to appear.

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“…In addition to a vitamin B12 deficiency, causes of non-compressive cervical myelopathy include copper deficiency, often due to gastric surgery or malabsorption syndromes such as celiac disease or zinc overconsumption, nitrous oxide exposure as a result of anesthetic or, more commonly, recreational use, and methotrexate chemotherapy (Renard et al, 2009;; Duque et al, 2015;; Cavallieri et al, 2016). Other atypical presentations involve infectious causes such as chikungunya virus infection (more common in India) and HIV vacuolar myelopathy (Garg et al, 2016).…”

Section: Discussionmentioning

confidence: 99%