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      Copper Deficiency Myeloneuropathy in Autoimmune Disease

      case-report
      Author(s): 1 , , 2
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: copper deficiency, copper-induced myelopathy, myeloneuropathy, diffuse systemic sclerosis, auto-immune, subacute combined degeneration, tabes dorsalis, serum vitamin b12

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          Abstract

          Copper deficiency is a rare and potentially treatable cause of myeloneuropathy. The most common causes of acquired copper deficiency include malabsorption following gastric surgery and excessive zinc supplementation. Clinical manifestations can be localized to the dorsal spinal cord and present similarly to those that characterize classic vitamin B12 deficiency. In this report, we present the case of a 76-year-old female with copper deficiency myeloneuropathy as a presumed consequence of advanced systemic sclerosis (SSc).

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          Severe intestinal dysbiosis is prevalent in primary Sjögren’s syndrome and is associated with systemic disease activity

          Thomas Mandl, Jan Marsal, Peter Olsson … (2017)
          Background Altered microbial composition of the intestine, commonly referred to as dysbiosis, has been associated with several autoimmune diseases including primary Sjögren’s syndrome (pSS). The aims of the current study were to study the intestinal microbial balance in pSS and to identify clinical features associated with dysbiosis. Methods Forty-two consecutive pSS patients and 35 age-matched and sex-matched control subjects were included in the study in an open clinic setting. Stool samples were analyzed for intestinal dysbiosis using a validated 16S rRNA-based microbiota test (GA-map™ Dysbiosis Test; Genetic Analysis, Oslo, Norway). Dysbiosis and severe dysbiosis were defined in accordance with the manufacturer’s instructions. Patients were evaluated with regard to disease activity (European League Against Rheumatism (EULAR) Sjögren’s Syndrome Disease Activity Index (ESSDAI) and Clinical ESSDAI (ClinESSDAI)). In addition, patients were examined for laboratory and serological features of pSS as well as fecal calprotectin levels. Furthermore, patients were investigated regarding patient-reported outcomes for pSS (EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI)) and irritable bowel syndrome (IBS)-like symptoms according to the Rome III criteria. Results Severe dysbiosis was more prevalent in pSS patients in comparison to controls (21 vs 3%; p = 0.018). Subjects with pSS and severe dysbiosis had higher disease activity as evaluated by the ESSDAI total score (13 vs 5; p = 0.049) and the ClinESSDAI total score (12 vs 5; p = 0.049), lower levels of complement component 4 (0.11 vs 0.17 g/L; p = 0.004), as well as higher levels of fecal calprotectin (110 vs 33 μg/g; p = 0.001) compared to the other pSS patients. In contrast, severe dysbiosis among pSS patients was not associated with disease duration, IBS-like symptoms, or the ESSPRI total score. Conclusions Severe intestinal dysbiosis is a prevalent finding in pSS and is associated both with clinical and laboratory markers of systemic disease activity as well as gastrointestinal inflammation. Further studies are warranted to elucidate a potential causative link between dysbiosis and pSS.
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            Gastrointestinal manifestations of systemic sclerosis

            Andrew B. Shreiner, Charles Murray, Christopher Denton … (2016)
            In patients with systemic sclerosis (SSc), gastrointestinal (GI)-tract involvement is almost universal. Any segment of the GI tract from mouth to anus can be involved, and GI symptoms are a frequent cause of morbidity. In severe cases, GI-tract involvement can progress to the point of malnutrition requiring parenteral nutrition. GI-tract involvement in SSc contributes to disease-related mortality although mostly as a co-morbidity rather than direct cause of death. The review is intended to help address challenges in the assessment and treatment of GI-tract involvement in SSc.
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              Dietary intake and nutritional deficiencies in patients with diabetic or idiopathic gastroparesis.

              Henry Parkman, Katherine Yates, William Hasler … (2011)
              Gastroparesis can lead to food aversion, poor oral intake, and subsequent malnutrition. We characterized dietary intake and nutritional deficiencies in patients with diabetic and idiopathic gastroparesis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 23 July 2021
                Publication date (Electronic, collection): July 2021
                Volume: 13
                Issue: 7
                Electronic Location Identifier: e16591
                Affiliations
                [1 ] Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
                [2 ] Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
                Author notes
                Jonathan T. Grossman jgdoneuro@ 123456gmail.com
                Article
                DOI: 10.7759/cureus.16591
                PMC ID: 8380469
                PubMed ID: 34434682
                SO-VID: 5abaa33c-0516-4f04-89cc-6010801ef722
                Copyright © Copyright © 2021, Grossman et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 23 July 2021
                Categories
                Subject: Internal Medicine
                Subject: Neurology
                Subject: Rheumatology

                Keywords: copper deficiency,copper-induced myelopathy,myeloneuropathy,diffuse systemic sclerosis,auto-immune,subacute combined degeneration,tabes dorsalis,serum vitamin b12
                Data availability:
                Keywords: copper deficiency, copper-induced myelopathy, myeloneuropathy, diffuse systemic sclerosis, auto-immune, subacute combined degeneration, tabes dorsalis, serum vitamin b12

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