Frequent use of zinc-containing denture adhesive can cause neurological trouble: a case of severe copper deficiency myeloneuropathy visible in T2w-STIR sequences of spinal MRI.

BACKGROUND: We report a case of severe copper deficiency myeloneuropathy due to frequent application of zinc-containing denture adhesive. Our case report is supposed to enhance the clinical awareness for this preventable neurological disease. CASE PRESENTATION: A 51-year-old patient presented with signs and symptoms of ataxia as well as spastic paraparesis and hyperreflexia. The patient reported hypesthesia with a sensory threshold at the level of T5 and a pallanesthesia of the lower extremities was determined. He could stand up with help but was unable to walk since May 2025. Laboratory tests revealed markedly reduced serum levels of ceruloplasmin and copper whereas zinc was elevated. He had been using zinc-containing denture adhesive up to five times per day for his dental protheses since a trauma with multiple tooth extractions 25 years ago. Standard MRI of the spine with T1- and T2-weighted MRI sequences was rated negative for any spinal cord abnormality. Only repeated MRI including T2w-STIR (short tau inversion recovery) sequences revealed a triangular signal enhancement in the cervical and upper thoracic spinal cord located in the posterior columns suggesting myelopathy. Copper gluconate supplementation (2 mg/d) and omission of zinc-containing denture adhesive led to a normalization of serum copper levels and slow recovery of neurological deficits during the following weeks of rehabilitation. In 2026, the patient reported improved symptoms and was able to walk again with help for short distances. CONCLUSIONS: In cases of suspected hypocupremic myeloneuropathy and a negative standard MRI of the spine, additional T2w-STIR sequences should be used to provide morphological evidence for this diagnosis. Zinc-free denture adhesive should be recommended to prevent severe neurological conditions resulting from prolonged copper deficiency.