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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Isolated neutropenia caused by copper deficiency due to jejunal feeding and excessive zinc intake: A case report
Hiromitsu Ohmori, Hiroko Kodama, Masahiko Takemoto, Masami Yamasaki, Tomio Matsumoto, Masao Kumode, Takafumi Miyachi, Ryo Sumimoto
Hiromitsu Ohmori, Department of Pediatrics, National Hospital Organization Yanai Medical Center, Yanai 742-1352, Yamaguchi, Japan
Hiroko Kodama, Doctoral Program in Health and Dietetics, Graduate School of Health Sciences, Teikyo Heisei University, Toshima-ku 170-8445, Tokyo, Japan
Masahiko Takemoto, Tomio Matsumoto, Ryo Sumimoto, Department of Surgery, National Hospital Organization Yanai Medical Center, Yanai 742-1352, Yamaguchi, Japan
Masami Yamasaki, Takafumi Miyachi, Department of Neurology, National Hospital Organization Yanai Medical Center, Yanai 742-1352, Yamaguchi, Japan
Masao Kumode, Department of Pediatrics, Biwako Gakuen Kusatsu Medical and Welfare Center for Children and Persons with Severe Motor and Intellectual Disabilities, Kusatsu 525-0034, Shiga, Japan
Author contributions: Ohmori H and Yamasaki M are the attending doctors; Takemoto M, Matsumoto T, and Sumimoto R created the percutaneous endoscopic gastrostomy with jejunal extension by an operation and managed it; Miyachi T, Kumode M and Kodama H provided consultations on the patient’s clinical problems and organized this manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed consent was obtained from the father of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hiroko Kodama, MD, PhD, Doctor, Special-appointed Professor, Doctoral Program in Health and Dietetics, Graduate School of Health Sciences, Teikyo Heisei University, 2-51-4 Higashi Ikebukuro, Toshima-ku 170-8445, Tokyo, Japan. kodamah2018@gmail.com
Received: May 28, 2021
Peer-review started: May 28, 2021
First decision: June 14, 2021
Revised: July 5, 2021
Accepted: September 2, 2021
Article in press: September 2, 2021
Published online: October 16, 2021
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 (53 μg/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/mm3) with a serum copper level of 16 μg/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.
Core Tip: Patients with percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) often develop copper deficiency. Approximately 2 mg/d of copper may be needed to prevent deficiency. The intake ratio of copper to zinc is critical for maintaining an adequate serum copper concentration. We report an isolated case of neutropenia caused by copper deficiency in a patient with neurological impairment receiving PEG-J feeding with additional supplementation of zinc. Copper deficiency improved with the addition of cocoa powder to the enteral formula.
