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Bayer G, Bauvois A, Mankikian J, Tardieu M, Maillot F, Salame E, Woimant F, Poujois A, Viana M, Legras A. [Ecchymosis as the presenting manifestation of Wilson disease: A case report]. Rev Med Interne 2016; 38:416-419. [PMID: 27639912 DOI: 10.1016/j.revmed.2016.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/21/2016] [Accepted: 08/09/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The presence of a psychiatric disorder during the course of an organic disease is a common cause of delayed diagnosis. CASE REPORT We report a 16-year-old girl who was admitted with thrombocytopenia and had a two-year history of neuropsychiatric disorder which was attributed to a difficult family situation. Neurological examination showed a frontal lobe disorder and extrapyramidal manifestations. The thrombocytopenia was attributed to liver cirrhosis. These neurological and hepatic injuries were consistent with a metabolic disease, most likely Wilson disease. This was supported by the presence of a corneal Kayser-Fleischer ring and a decreased ceruloplasmin concentration. An urgent liver transplantation was required due to worsening neurological symptoms. CONCLUSION Wilson disease is a rare genetic disease caused by copper toxicity. It is characterized by combined hepatic and neurologic damage to varying degrees and can develop at any age. Urgent treatment is required, but the diagnosis may be delayed by prevailing psychiatric symptoms.
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Affiliation(s)
- G Bayer
- Réanimation polyvalente, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Médecine interne, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
| | - A Bauvois
- Réanimation polyvalente, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Médecine interne, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - J Mankikian
- Réanimation polyvalente, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - M Tardieu
- Médecine pédiatrique, CHRU de Tours, 49, boulevard Béranger, 37000 Tours, France
| | - F Maillot
- Médecine interne, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; UFR de médecine, université François-Rabelais, Tours, France
| | - E Salame
- UFR de médecine, université François-Rabelais, Tours, France; Chirurgie digestive, oncologique et endocrinienne, transplantation hépatique, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - F Woimant
- Centre national de référence de la maladie de Wilson, CHU Lariboisière, AP-HP, Paris, France
| | - A Poujois
- Centre national de référence de la maladie de Wilson, CHU Lariboisière, AP-HP, Paris, France
| | - M Viana
- Ophtalmologie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - A Legras
- Réanimation polyvalente, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
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Zimbrean PC, Schilsky ML. Psychiatric aspects of Wilson disease: a review. Gen Hosp Psychiatry 2014; 36:53-62. [PMID: 24120023 DOI: 10.1016/j.genhosppsych.2013.08.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/14/2013] [Accepted: 08/29/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review the current evidence about psychiatric symptoms in Wilson's disease (WD). METHOD We searched Ovid, PsychInfo, CINHAL and PubMed databases from May 1946 to May 2012 using the key words Wilson('s) disease in combination with psychiatry, psychiatric, psychosis, schizophrenia, depression, mania, bipolar, mood, anxiety, personality and behavior. RESULTS Psychiatric symptoms occur before, concurrent with or after the diagnosis and treatment for WD. Thirty to forty percent of patients have psychiatric manifestations at the time of diagnosis, and 20% had seen a psychiatrist prior to their WD diagnosis. When psychiatric symptoms preceded neurological or hepatic involvement, the average time between the psychiatric symptoms and the diagnosis of WD was 864.3 days. The prevalence of psychiatric disorders in WD patients varies wildly (major depressive disorder, 4-47%; psychosis, 1.4-11.3%). Certain gene mutations of ATP7B may correlate with specific personality traits. CONCLUSIONS Psychiatric manifestations represent a significant part of the clinical presentation of WD and can present at any point in the course of the illness. Psychiatric manifestations occurring without overt hepatic or neurologic involvement may lead to misdiagnosis. A better understanding of the psychiatric presentations in WD may provide insights into the underlying mechanisms of psychiatric disorders.
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Affiliation(s)
- Paula C Zimbrean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Wilson Disease Centers of Excellence at Yale University, New Haven, CT.
| | - Michael L Schilsky
- Wilson Disease Centers of Excellence at Yale University, New Haven, CT; Section of Digestive Disease and Transplant and Immunology, Yale University School of Medicine; Yale Transplantation Center, Yale New Haven Hospital, New Haven, CT
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Vital Durand D, Lega JC, Fassier T, Zenone T, Durieu I. Élévation modérée, persistante et inexpliquée des transaminases. Rev Med Interne 2013; 34:472-8. [DOI: 10.1016/j.revmed.2013.02.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 02/28/2013] [Accepted: 02/28/2013] [Indexed: 12/18/2022]
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