Copper Deficiency Myeloneuropathy — RACP Adult Medicine MCQ

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HardNeurologyCopper Deficiency MyeloneuropathyRACP Adult Medicine

A 55-year-old woman with a history of bariatric surgery (Roux-en-Y) 5 years ago presents with progressive paraesthesiae and weakness in all limbs. Her copper level is undetectable and caeruloplasmin is low. MRI spine shows dorsal column signal abnormality. What is the diagnosis?

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Correct answer: E — Zinc toxicity

Copper deficiency causes a myeloneuropathy clinically indistinguishable from B12 deficiency (dorsal column and corticospinal tract involvement). It occurs after bariatric surgery (malabsorption), excess zinc supplementation (zinc inhibits copper absorption), or chronic TPN without copper supplementation. Undetectable serum copper with low caeruloplasmin confirms the diagnosis. Haematological features include sideroblastic anaemia and neutropaenia. Treatment is IV or oral copper supplementation. Recovery is variable and often incomplete, highlighting the importance of regular micronutrient monitoring post-bariatric surgery.

Reference: eTG – 2025 – Neurology; ANZOS – 2024 – Post-Bariatric Nutritional Guidelines