case_images: PMC8384003_01
case_images: Clinical course before his presentation. Zn = Zinc; Hb = Hemoglobin; Ret = Reticulocytes; Plt = Platelets; WBC = White blood cells
case_images: JRMS-26-42-g001.jpg
case_images: PMC8384003_01_JRMS-26-42-g001.jpg
case_images: F1
case_images: He had ESA-resistant anemia and was prescribed zinc acetate hydrate formulation (NOBELZIN) 50 mg three times a day after meals about 6 months before his presentation. He was found to have pancytopenia 1 month before his presentation, at which point, he was introduced to our hospital [Figure 1].
case_images: Clinical course after stopping Zn and starting Cu. Zn = Zinc; Cu = Copper; Hb = Hemoglobin; Ret = Reticulocytes; Plt = Platelets; WBC = White blood cells
case_images: JRMS-26-42-g002.jpg
case_images: PMC8384003_01_JRMS-26-42-g002.jpg
case_images: F2
case_images: Hb level >8.0 mg/dl and Plt level >10-20 x 103/mul. His copper serum and ceruloplasmin levels recovered within 2 months, and his pancytopenia improved [Figure 2].