419 - A Penny for Your Thoughts: A Case of Copper Deficiency Myeloneuropathy in the Inpatient Rehabilitation Setting

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

ML

Maxwell Langer, MD

Resident Physician
Indiana University
Indianapolis, Indiana, United States

Co-Author(s)

SD

Shashank Dave, DO

Clinical Associate Professor
Indiana University School of Medicine
Indianapolis, Indiana, United States

Case Diagnosis: Severe copper deficiency myeloneuropathy following previous bariatric surgery

Case Description: Our patient is a 50-year-old female with history of gastric bypass surgery in 2007 who developed severe neurological symptoms beginning in 2020. The patient first noted diminished proprioception in her feet and presented with progressively worsening weakness, gait disturbances, and paresthesias. She initially underwent robust evaluation by her primary care physician including extensive MRI brain and spine imaging as well as a battery of lab work revealing profoundly diminished serum copper levels and reinforcing the diagnosis of copper deficiency myeloneuropathy. Prior to initiating copper supplementation her weakness had progressed to the point of wheelchair dependence and she was requiring progressively more assistance with ADLs. She was referred to an outpatient physiatry clinic for further treatment and rehabilitation recommendations. Given her profound and progressive debility the patient was accepted for direct admission to a local rehabilitation hospital for dedicated acute inpatient rehabilitation directly following a 7-day course of IV copper supplementation.

Discussions: Copper deficiency myeloneuropathy post-gastric bypass surgery is a rare but treatable condition. Clinicians should be vigilant in monitoring patients with a history of gastric bypass surgery for potential micronutrient deficiencies, including copper. Early recognition, supplementation, and dedicated rehabilitation are essential to prevent irreversible neurological damage and improve patients' quality of life particularly in severe cases as presented here.

Conclusions: Following 19-days of inpatient rehabilitation our patient was able to rapidly improve in both her strength and function reaching modified independence from a wheelchair level with most mobility tasks and ADLs. Following her course of inpatient rehabilitation she was able to successfully transition home with the supervision of her family and has been continuing to participate in outpatient therapies. This case highlights the diagnosis, treatment, and vital role of inpatient rehabilitation in an advanced case of copper deficiency myeloneuropathy.