As described in the very recent case report by New England Journal of Medicine (Case 2-2017), the chelation therapy would increase the serum copper concentration and cause the worsening of neurological symptoms in Wilson's disease. I would like to have a discussion on the potential risk of the standard therapy with D-penicillamine.
This case report is worth reading to better understand the characteristics of fulminant hepatitis associated with Wilson's disease as compared with typical acute hepatic failure.
Article Case 2-2017: An 18-Year-Old Woman with Acute Liver Failure
The Case 2-2017 did not use dimerkaprol for Wilson in chelation cure. Is it related to the increased serum copper concentration when the Wilson's patients who exhibit acute liver failure were receiving the chelation therapy with D-penicillamine only?
Thank you, Dr Püreda Yazıcı. I strongly recommend you to write a Letter to the Editor of NEJM Case Record 2-2017.
A clinical deterioration occurs after the start of chelating therapy very often. This is a temporary phenomenon.Usually, the dose of D-penicillamine should be lowered slightly for few weeks/months and then again increased to maximum tolerated (within acceptable therapeutic).
Also, I have had some experience with Trientine and there was the same problem.
It is well known and expected, so all we can do is to warn patient about it and to titrate dosage...
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