(Kiosk 4) Neurologic Sequelae of Acquired Copper Deficiency Following Gastric Bypass Surgery - A Case Report

Case Diagnosis: Sensory polyneuropathy due to acquired copper deficiency following gastric bypass surgery

Case Description or Program Description: A 44-year-old female with a history of gastric bypass surgery in 2011 (subsequently lost to follow-up) and substance abuse disorder initially presented to her pulmonologist with fatigue and dyspnea. She was found to have hemoglobin of 3.1 and leukopenia of 1.8, which prompted a referral to the ED. Upon admission, she endorsed a 6-month history of progressive blurred vision, dysphagia, urinary incontinence, proximal weakness, length-dependent numbness, and painful paraesthesias in all extremities. Exam was notable for dysphonia, impaired swallow function, mild proximal weakness, decreased light touch sensation in a length-dependent fashion in all extremities, and impaired proprioception at bilateral ankles and wrists. Her hospital course was complicated by pica, severe neuropathic pain, and neurogenic bladder.

Setting: Tertiary care hospital

Assessment/Results: Extensive neurological workup was notable only for undetectable serum copper levels, which was attributed to medication nonadherence following gastric bypass surgery. Bone marrow biopsy confirmed dysplastic changes consistent with copper deficiency. The patient received blood transfusions and IV copper repletion. She was initially recommended for acute rehabilitation due to impairments in cognition, strength, and sensation leading to decreased endurance and functional mobility, with PT evaluation noting a Berg score of 19/56. Dysphagia improved and diet was successfully upgraded to regular consistency. Neuropathic pain improved with the initiation of pregabalin. The neurogenic bladder was managed using timed voids. The patient’s strength improved and she was deemed safe for discharge to home with home therapies.

Discussion (relevance): This is the first reported case, to our knowledge, of multisystem sequelae of acquired copper deficiency following gastric bypass surgery leading to significant functional decline.

Conclusions: Acquired copper deficiency is a rare but preventable complication of bypass surgery. Copper deficiency presents with a unique constellation of sequelae and functional impairments that require the development of a comprehensive rehabilitation plan.