[A case of scleroderma with pancytopenia due to lack of trace elements]

A 66-year-old woman with systemic scleroderma developed pancytopenia (white blood cell 750/microliter, neutrophilic cell 201/microliter, red blood cell 166 x 10(4)/microliter, hemoglobin 5.3 g/dl, hematocrit 18.1%, platelet cell 8.2 x 10(4)/microliter) 7 months after the initiation of intravenous hyper-alimentation for chronic ileus. Serum copper and zinc levels were 3 and 46 micrograms/dl, respectively. Provision of trace elements led to increase blood cell counts as well as serum copper and zinc levels. She also developed watery diarrhea frequent times a day and hypoproteinemia during the lack of trace elements. Evidence of protein-losing gastroenteropathy was shown by gastrointestinal scintigraphy using 99mTc-human serum albumin half a year after provision of trace elements and it was not shown one and a half years after continuous provision of trace elements. As patients with scleroderma sometimes develop gastrointestinal problems and are needed intravenous nutrition of long duration, they should be paid attention to lack of trace elements that can be a cause of hematologic complications.