BACKGROUND Percutaneous endoscopic gastrostomy with jejunal extension(PEG-J)is often used to treat patients with neurological impairment and difficulty in swallowing.However,these patients often develop copper deficie...BACKGROUND Percutaneous endoscopic gastrostomy with jejunal extension(PEG-J)is often used to treat patients with neurological impairment and difficulty in swallowing.However,these patients often develop copper deficiency.This report describes a case of isolated neutropenia,which is a rare manifestation of copper deficiency.CASE SUMMARY Our patient was a 19-year-old boy with neurological impairment and gastroesophageal reflux.He received PEG-J feeding,including an enteral supplement containing copper and zinc.However,as his serum zinc level was low(53μg/dL)at the age of 19 years and 2 mo,we changed to a zinc-rich supplement containing 22 mg/d of zinc and 1.0 mg/d of copper.The supplement comprised a mixture of isocal 1.0 junior(5 packs/d),Tezon[2 packs(250 mL)/d],and cocoa powder.Seven months later,he had neutropenia(606/mm^(3))with a serum copper level of 16μg/dL.There were no other manifestations of copper deficiency,including anemia.Copper deficiency and neutropenia both improved following the administration of cocoa powder and Tezon.CONCLUSION In patients receiving long-term PEG-J feeds,white blood cell counts,hemoglobin,and serum levels of copper and zinc should be regularly monitored.展开更多
文摘BACKGROUND Percutaneous endoscopic gastrostomy with jejunal extension(PEG-J)is often used to treat patients with neurological impairment and difficulty in swallowing.However,these patients often develop copper deficiency.This report describes a case of isolated neutropenia,which is a rare manifestation of copper deficiency.CASE SUMMARY Our patient was a 19-year-old boy with neurological impairment and gastroesophageal reflux.He received PEG-J feeding,including an enteral supplement containing copper and zinc.However,as his serum zinc level was low(53μg/dL)at the age of 19 years and 2 mo,we changed to a zinc-rich supplement containing 22 mg/d of zinc and 1.0 mg/d of copper.The supplement comprised a mixture of isocal 1.0 junior(5 packs/d),Tezon[2 packs(250 mL)/d],and cocoa powder.Seven months later,he had neutropenia(606/mm^(3))with a serum copper level of 16μg/dL.There were no other manifestations of copper deficiency,including anemia.Copper deficiency and neutropenia both improved following the administration of cocoa powder and Tezon.CONCLUSION In patients receiving long-term PEG-J feeds,white blood cell counts,hemoglobin,and serum levels of copper and zinc should be regularly monitored.
