A case of Wilson disease treated as schizophrenia for 20 years

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A 42-year-old man, who had been diagnosed as schizophrenia due to memory disturbance, mental disorder and delusion of persecution at age of 20, was referred to our hospital due to progressive neurological symptoms and unknown liver dysfunction. He had previously been diagnosed as nonalcoholic steatohepatitis or drug-induced liver injury in some other hospitals. Later, he presented with difficulty in walking and akinesia like drug-induced parkinsonism. On admission, his laboratory findings showed low levels of serum ceruloplasmin and the increase of 24-h urinary copper excretion. Kayser-Fleischer rings were demonstrated. Histological examination of the liver revealed cirrhosis and the hepatic copper concentration was elevated. MRI of the brain showed high-intensity signal area at the basal ganglia. We diagnosed him as Wilson disease and started treatment with trientine and zinc acetate, and also started rehabilitation. His mental disorder, parkinsonism and biochemical data have apparently improved after the initiation of the treatment.