BMJ Case Reports 2017; doi:10.1136/bcr-2017-219802
  • Reminder of important clinical lesson

Zinc containing dental fixative causing copper deficiency myelopathy

  1. Rosanne Murray
  1. Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
  1. Correspondence to Dr Liam Stuart Carroll, liamcarroll{at}
  • Accepted 22 June 2017
  • Published 8 August 2017


A 62-year-old male, previously well, was referred to neurology clinic following 6 months history of worsening lower limbs instability, paraesthesia, pain and weakness rendering him housebound. Examination revealed upper motor neuron pattern of weakness of the lower limbs and loss of proprioception. Serum analysis revealed reduced caeruloplasmin and copper levels with raised zinc. Spinal imaging revealed subtle dorsal column intensity changes in C2-C7, confirmed with 3T MRI. A copper deficiency myeloneuropathy was diagnosed secondary to chronic use of a zinc-containing dental fixative paste. The paste was discontinued and a copper supplementation was started. Resolution of symptoms was not achieved with intensive physiotherapy. The patient remains a wheelchair user though progression of symptoms has halted. Prompt recognition and treatment of hyperzincaemia-induced hypocupraemia earlier in the disease course may have prevented any irreversible neurological deficit.


  • Contributors LC prepared the manuscript, AAR prepared the image and reviewed the manuscript, RM reviewed the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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