Anemia following zinc treatment for Wilson's disease: a case report and literature review

BackgroundZinc therapy is considered an effective and safe treatment for Wilson's disease. Hypocupremia-related anemia is rarely reported after long-term zinc administration or combination therapy with copper-chelating agent.Case presentationWe herein report a 12-year-old girl with pre-symptomatic Wilson's disease diagnosed 5years ago who presented with severe anemia after high-dose oral zinc for 4years and 4months. Her hemoglobin was gradually restored to the normal range after the adjustment of zinc dose and diet therapy for 4months. A review of the literature revealed eight patients with hypocupremia-associated anemia following zinc therapy for Wilson's disease, including 7 adults and 1 child. The only child patient was a 16-year-old boy, in whom the zinc therapy was succession to penicillamine administration.ConclusionsThis is the first report worldwide that a child developed severe anemia following high-dose single zinc administration for Wilson's disease. It highlights the importance of regular follow-up during zinc treatment and the involvement of specialists in the long-term management of Wilson's disease. We hope that this will alert pediatricians the issue of zinc over-treatment.