Copper Deficieny in a Patient with AIDS Cholangiopathy and Cryptosporidium Diarrhea

Abstract

Objective:

To report a case of leukopenia caused by copper deficiency in a patient with AIDS cholangiopathy and Cryptosporidium diarrhea who required total parenteral nutrition (TPN).

Case Summary:

A 36-year-old white man with AIDS had Cryptosporidium diarrhea, and produced a daily stool volume of 3–5 L. He also had AIDS cholangiopathy, with intra- and extrahepatic biliary dilation and an alkaline phosphatase concentration of 3,000 U/L. He required TPN. Since copper is excreted primarily through the bile, it was omitted from his TPN. The patient then developed progressive leukopenia. His plasma copper concentration dropped to 10.2 μg/dL. Copper was subsequently added to the TPN, and the white blood cell count returned to normal.

Discussion:

A review of the literature showed that neither HIV infection nor AIDS is associated with copper deficiency. Copper deficiency has been reported as a rare complication of TPN or malabsorption, but it was not expected as a result of AIDS cholangiopathy.

Conclusions:

Copper supplementation is required in TPN in patients with chronic diarrhea and AIDS cholangiopathy. Additionally, copper deficiency is a potential cause of leukopenia in patients with AIDS who are receiving TPN or who have chronic diarrhea.