Copper responsive anemia, induced by oral zinc therapy in a patient with acrodermatitis enteropathica

Normocytic anemia with granulocytopenia occurred in a 23 year old man with acrodermatitis enteropathica who received high doses of zinc sulphate orally for 12 months. Copper deficiency was suspected to be the cause of this anemia when extreme hypocupremia and hypoceruloplasminemia were found. Oral zinc therapy was stopped and intravenous supplements of copper were followed by reticulocytosis and complete correction of the anemia and granulocytopenia. Plasma copper and ceruloplasmin levels normalized. Up to now copper deficiency has never been reported during zinc treatment in acrodermatitis enteropathica. We conclude that the copper status should be monitored during oral zinc therapy in this condition.