Manic Episode Induced by Discontinuance of D-Penicillamine Treatment in Wilson's Disease

Wilson's disease (WD) is a rarely seen autosomal recessive inherited genetic disease of copper metabolism, which leads to various hepatic, orbital and neuropsychiatric disorders. Neuropsychiatric symptoms are due to degeneration that results from the acccumulation of copper in the neurons of the brain, especially in the basal ganglia. Clinicians should consider that toxicity of copper might trigger the episode in a patient with WD, who displays a manic episode. When persistent manic symptoms are encountered in WD, treatment of copper toxicity should be checked and necessary consultation should be performed. In this case report, a patient with WD who developed a manic episode as a result of stopping d-penicillamine treatment is presented, and improvement of clinical symptoms when d-penicillamine was added to the psychiatric treatment is emphasized.