Not so Element-ary: A Copper Conundrum

Abstract

Copper is an essential micronutrient required for a number of enzymatic activities. Deficiency is relatively rare as only trace amounts are needed to maintain homeostasis. Deficiencies however do occur and are most commonly seen in malabsorptive states such as after bariatric surgeries. Herein, we present an interesting case of copper deficiency diagnosed in a 70-year-old male patient post duodenal switch procedure which persisted despite aggressive oral and intravenous copper supplementation. This lack of response to supplementation prompted further evaluation, leading to a diagnosis of underlying heterozygous Wilson's disease.

Keywords: copper; duodenal switch; wilson disease.

Figure 1. Liver biopsy showing mild macrovesicular steatosis and cholestasis