Extremity swelling in an infant with copper and zinc deficiency

A female infant born with jejunal atresia and a severely shortened bowel acquired progressive thickening of her thighs at 7 mo of age. While receiving parenteral nutrition, all four extremities rapidly became massively thickened and tender, and the child made no effort to move them. X-rays revealed large subperiosteal hematomas encompassing each femur, tibia, and humerus as the cause of the swelling. Ascorbic acid levels in the serum were not diminished, but copper and zinc levels were extremely low. Treatment with a trace element solution that included copper reversed the extremity thickening and the pseudoparalysis.