1227 - Copper Deficiency Myeloneuropathy Due to Use of Zinc-Containing Denture Adhesive: A Case Report

Case Diagnosis: Copper Deficiency Myeloneuropathy Due to Denture Adhesive

Case Description: A 73-year-old woman with history of vitamin B12 deficiency s/p replacement, originally presented to a local emergency department in April of 2023 with progressive weakness and paresthesia’s of the lower extremities. This was thought to be due to Subacute Combined Degeneration. After 9 months of continued progression of symptoms and 9 falls, work up at our university hospital showed decreased serum copper and hyper intensity in the C2-C7 dorsal spine consistent with copper deficiency myelopathy. Previously independent with all Activities of Daily Living (ADLs), she was now tetraplegic with significant impairments due to deficits in coordination and proprioception requiring a power wheelchair. Etiology was derived from daily use of Zinc-containing denture adhesive. During her inpatient rehab stay, she improved in strength, stand pivot transfers in the setting of impaired balance, and lower extremity dressing with significant paresthesia’s. Patient copper was repleted but her impairments were mostly non-reversible.

Discussions: Copper Deficiency Myeloneuropathy (CDM) is an recognized mimic of Subacute Combined Degeneration (SCD) however CDM is typically reversible. Though not the first reported case of CDM due to use of Zinc-containing denture adhesive, this entity is becoming less rare, as the healthcare system begins to care for an older population. This diagnosis should be considered when patients show subacute progressively worsening symptoms of paresthesia’s and tetraplegia.

Conclusions: This case describes the serious irreversible progressive spinal cord injuries that can be seen in Copper Deficiency Myeloneuropathy (CDM).