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Extremity swelling in an infant with copper and zinc deficiency
Insights
A severe bowel condition in an infant led to limb swelling and immobility due to subperiosteal hematomas. Trace element supplementation, specifically copper, successfully reversed these symptoms, highlighting a critical link between nutrition and bone health.
Area of Science:
- Pediatric Medicine
- Nutritional Science
- Skeletal Biology
Background:
- Jejunal atresia and short bowel syndrome can necessitate long-term parenteral nutrition.
- Nutritional deficiencies can manifest in various systemic complications, including skeletal issues.
Observation:
- An infant with jejunal atresia developed progressive, tender limb thickening and pseudoparalysis at 7 months of age.
- Radiographic imaging revealed extensive subperiosteal hematomas in all four extremities.
- Serum analysis showed normal ascorbic acid but critically low copper and zinc levels.
Findings:
- The subperiosteal hematomas were the direct cause of the limb swelling and immobility.
- Copper and zinc deficiencies were strongly implicated in the pathogenesis of the hematomas and pseudoparalysis.
- Treatment with a trace element solution containing copper resulted in the resolution of limb thickening and restoration of movement.
Implications:
- This case underscores the importance of monitoring trace element levels, particularly copper and zinc, in infants receiving long-term parenteral nutrition.
- Early identification and supplementation of specific micronutrients can prevent severe skeletal complications and improve outcomes in infants with complex gastrointestinal conditions.
- Highlights a potential link between copper deficiency and subperiosteal hematoma formation, a rare but serious complication.
Abstract:
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.