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Heavy Metal Labor- Patient Rocking Wilson's Disease
Abstract Number: F-79
Abstract Type: Case Report/Case Series
A rare case of copper toxicity in a parturient with Wilson’s disease.
A 32 y/o G2P0 at 13 weeks’ gestation with known Wilson’s disease that was diagnosed in 2014, and history of IVDA presented for MFM consult with exacerbation of her neurologic symptoms including: altered mental status, weakness, dysphagia, dysarthria, gait disturbance and increasing tremors. Patient had increasing neurologic symptoms subsequent to withdrawal of her chelation therapy drugs for a known pregnancy. The patient was previously on trientine, gabapentin, levetiracetam, carbidopa-levodopa, and trihexyphenidyl. She was switched from chelation therapy to treatment with zinc acetate. Her laboratory values showed no signs of liver failure, but her neurologic status continued to deteriorate and she was intubated for airway protection. Plasmapheresis was initiated for copper toxicity. The patient was unable to have a PEG tube placement due to her gravid uterus, and had an NG tube throughout the remainder of pregnancy. Serum copper level was 66 and ceruloplasmin level 18 prior to plasmapheresis. Her weakness and bulbar symptoms improved after plasmapheresis and follow up MRI showed no new cranial lesions or signs of encephalitis. Patient’s worsening neurologic status was presumed to be due to increasing copper in her brain parenchyma and the symptoms improved after resuming her original therapy with tryihexyphenidyl and trientine. This patient’s neurologic symptoms slowly improved after approximately 6 weeks of hospitalization, re-initiation of chelation therapy, and intensive OT/PT. Patient decided to continue with pregnancy and adamantly refused termination. She was then seen for induction of labor at 40 weeks and 6 days. A labor epidural was placed without complications, and she had a NSVD of a 3138g male infant. A Nexplanon was inserted prior to discharge and she continued her chelation therapy with trihexyphenidyl and trientine.
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Hyun JL, et al. Successful pregnancy outcome in a Korean patient with symptomatic Wilson’s disease. Obstet Gynecol Science 2015; 58 (5) 409-413.